Abstract
An 85 year-old woman was transferred with a chief complaint of right thigh pain persisting for 5 days. Abdominal contrast-enhanced computed tomography clearly depicted a swollen appendix incarcerated in the right obturator cavity. She underwent an emergent laparoscopic appendectomy and the simultaneous repair of the obturator hernia. At laparoscopy, appendix was found to be incarcerated in the right obturator canal. The incarcerated appendix was successfully flushed out from the sac by spurting saline into the obturator hernia sac through the catheter inserted into the hernia sac. After a laparoscopic appendectomy, the hernia orifice was repaired using the uterine flap. The patient was discharged from the hospital without any sequelae. This report demonstrates a very rare case of obturator hernia incarcerated with appendix. Although patients with obturator hernia incarcerated with small intestine present with the symptoms related to bowel obstruction, patients with incarceration of appendix do not. Moreover, they would show no typical abdominal symptoms associated with acute appendicitis. Therefore, it is important to perform a radiological evaluation promptly to make a definitive diagnosis when a patient with persisting pain of the right thigh or right ileac fossa with a possibility of obturator hernia with incarceration of the appendix is encountered.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Losanoff JE, Richman BW, Jones JW. Obturator hernia. J Am Coll Surg. 2002;194:657–63.
Bjork KJ, Mucha P Jr, Cahill R. Obturator hernia. Surg Gynecol Obstet. 1988;167:217–22.
Schizas D, Apostolou K, Hasemaki N, et al. Obturator hernias: a systematic review of the literature. Hernia. 2021;25:193–204.
Gray SW, Skandalakis JE, Soria RE, et al. Strangulated obturator hernia. Surgery. 1974;75:20–7.
Lo CY, Lorentz TG, Lau PW. Obturator hernia presenting as small bowel obstruction. Am J Surg. 1994;167:396–8.
Yokoyama Y, Yamaguchi A, Isogai M, et al. Thirty-six cases of obturator hernia: does computed tomography contribute to postoperative outcome? World J Surg. 1999;23:214–6.
Cubillo E. Obturator hernia diagnosed by computed tomography. AJR Am J Roentgenol. 1983;140:735–6.
Chan KV, Chan CKO, Yau KW, et al. Surgical morbidity and mortality in obturator hernia: a 10 year retrospective risk factor evaluation. Hernia. 2014;18:387–92.
Hayama S, Ohtaka K, Takahashi Y, et al. Laparoscopic reduction and repair for incarcerated obturator hernia: comparison with open surgery. Hernia. 2015;19:809–14.
Chang SS, Shan Y-S, Lin Y-J, et al. A review of obturator hernia and a proposed algorithm for its diagnosis and treatment. World J Surg. 2005;29:450–4.
Cueto-García J, Rodríguez-Diaz M, Elizalde-Di Martino A, et al. Incarcerated obturator hernia successfully treated by laparoscopy. Surg Laparosc Endosc. 1998;8:71–3.
Miki Y, Sumimura J, Hasegawa T, et al. A new technique of laparoscopic obturator hernia repair: report of a case. Surg Today. 1998;28:652–6.
Tucker JG, Wilson RA, Ramshaw BJ, et al. Laparoscopic herniorrhaphy: technical concerns in prevention of complications and early recurrence. Am Surg. 1995;61:36–9.
Togawa Y, Muronoi T, Kawaguchi H, et al. Minimal incision transinguinal repair for incarcerated obturator hernia. Hernia. 2014;18:407–11.
Shapiro K, Patel S, Choy C, et al. Totally extraperitoneal repair of obturator hernia. Surg Endosc. 2004;18:954–6.
Archampong EQ. Preoperative diagnosis of strangulated obturator hernia. Postgrad Med J. 1968;44:140–3.
Hartley BE, Davies MS, Bowyer RC. Strangulated appendix in an obturator hernia presenting as gas gangrene of the thigh. Br J Surg. 1994;81:1135.
Kjossev KT, Losanoff JE. Gangrenous appendicitis in a strangulated obturator hernia. South Med J. 2003;96:1042–3.
Camerlinck M, Vanhoenacker F, De Vuyst D, et al. Appendicitis in an obturator hernia. Abdom Imaging. 2011;36:170–3.
Mitchell DE, Yunaev M. Acute appendicitis within an obturator hernia. BMJ Case Rep. 2015. https://doi.org/10.1136/bcr-2015-211416.
Kelly CH, Teicher EJ. Subtotal appendectomy to treat gangrenous appendicitis incarcerated in an obturator hernia. Am Surg. 2021;31:31348211023421.
Morioka H, Aoki J, Fu**o K, et al. A case of ileus surgery using the water pressure method against ileus caused by incarceration into the inverted bladder diverticulum. Surg Case Rep. 2020;6(1):9. https://doi.org/10.1186/s40792-019-0766-7.
Holm MA, Fonnes S, Andresen K, et al. Laparotomy with suture repair is the most common treatment for obturator hernia: a sco** review. Langenbecks Arch Surg. 2021;406(6):1733–8.
Author information
Authors and Affiliations
Contributions
All authors contributed to the conception, design, performed material preparation, and data collection. The manuscript was written by RM. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Informed consent
Informed consent was obtained from all patients to be included in the study.
Human/animal rights
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Mizuno, R., Takeuchi, G., Ueda, Y. et al. A case of acute appendicitis incarcerated in obturator hernia. Clin J Gastroenterol 15, 941–945 (2022). https://doi.org/10.1007/s12328-022-01681-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12328-022-01681-x