A Case of Metachronous Bilateral Obturator Hernia Probably Caused by Emaciation Due to Advanced Gastric Carcinoma
Year: 2000
Type: article
Study design: Case Report
Abstract: Obturator hernia commonly occurs in aged thin women, and there have been 300 cases in the japanese literature so far. The preoperative correct diagnosing rate is as low as 30.5%, and resection of the intestine at operation is performed in about 60% of such cases. This time we experienced a case of metachronous bilateral obturator hernia, which is rare, with advanced gastric cancer. A 69-year-old woman was admitted to the hospital because of lower abdominal pain and pain extending down the inner surface of her right thigh to the right knee (Howship-Romberg sign). On admission, she was very thin and weighed 36kg. X-ray contrast examination showed obstruction of the small intestine at the site of right obturator foramen. Under a preoperative diagnosis of right obturator hernia, an emergency operation was performed. At laparotomy the ileum was incacerated into the right obturator foramen. Postopertive course was uneventful and she was discharged on the 16th postoperative day. She returned to the hospital complaining of vomiting with abdominal pain 3 years after the first operation. She lost 2kg and weighed 37kg on the readmission. Pelvic CT scan showed an incarceration of the left obturator hernia. The second operation required no resection of the intestine. She complained of dysphagia 3 months after the second operation. Panendoscopic observation revealed a 3'typed advanced gastric carcinoma located at the cardia. In a review of the Japanese literature metachronous bilateral obturator hernias have been reported in only five cases including this case. In four previous cases, an obturator hernia on the contralateral side occurred within 21 weeks after reduction of the initial hernia. This relativly short interval from the reduction until the onset of contralateral hernia might be explained by a fact that fatty tissue covering the contralateral obturator decreased dut to the first operation and fasting. In this case, the contralateral obturator hernia occurred after long interval of 3 years that might be caused by emaciation secondary to the development of gastric cancer. We must entertain aprobable association of malignancy in case of metachronous bilateral obturator hernia with long interval between two operations.
DOI: 10.3919/jjsa.61.518
Language: English
Topic: Hernia repair and management
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W1998548343