骨盤部CTが術前診断に有用であった閉鎖孔ヘルニアの2例

Abstract

Although obturator hernia is a relatively rare disease, it has been reported that the disease usually occurs in aged thin women who have experienced multiple deliveries. Patients with obturator hernia do not usually complain of severe abdominal pain due to Richter's hernia, resulting in delayed diagnosis and high mortality rates. We recently experienced two cases of obturator hernia diagnosed preoperatively by pelvic computed tomography (CT). Two women aged 87 and 77 years were admitted to our hospital due to vomiting and diagnosed immediately as ileus by abdominal X-ray examination. Because they did not complain of severe abdominal pain and no peritoneal irritation signs such as the Blumberg's sign and muscular defence were observed, they were treated conservatively by inserting a long tube. Ileus, however, did not improve despite the treatment. Pelvic CT was performed 5 and 6 days after the insertion of a long tube on the former case and the latter case, respectively. Pelvic CT clearly revealed the incarcerated intestine in the right obturator foramen in both cases, resulting in the preoperative diagnosis of obturator hernia. Upon operation obturator hernia was repaired and the hernia opening was closed. Although excision of the small intestine was required in both cases, they made satisfactory progress after the operation. It is not easy to make a definite diagnosis of obturator hernia and the resultant delay in diagnosis contributes to a high mortality rate of obturator hernia. Therefore, in the treatment of aged women presenting ileus, it is important to take obturator hernia into consideration. Furthermore, it should be noted that pelvic CT is very useful for early diagnosis of obturator hernia.