title: Computed tomography in the investigation and management of obturator hernia.
abstract: BACKGROUND
  Obturator hernias are a rare groin hernia. They are most commonly found incidentally during laparoscopic inguinal hernia repair. We investigated our experience with obturator hernias in the elective and emergency setting.
  
  
  METHODS
  Cases of obturator hernia were identified from a hospital database and reviewed retrospectively over the last 10 years. There were no exclusions. There were a number of surgeons involved with an interest in groin hernia surgery.
  
  
  RESULTS
  Twenty-one patients were included. The mean age was 66 years old. Eleven were male. There were four emergency presentations. One emergency case presented with small bowel obstruction, while the other three cases presented with groin pain. Two patients had a preoperative computed tomography, which showed an obturator hernia confirmed at surgery. The patient with small bowel obstruction had an open bowel resection alone with no hernia repair. They were discharged with no complications or recurrence on follow-up. The other three cases had a mesh repair (one laparoscopic, one laparotomy, one pre-peritoneal). One patient who underwent a laparotomy died of a post-operative pneumonia. The others were discharged uneventfully. In the elective group of 17 patients, 8 patients were taken for an elective laparoscopic inguinal hernia repair but found to actually have an obturator hernia alone. An obturator hernia was found incidentally with an inguinal hernia in three patients. Five patients were expected to have an obturator hernia on clinical examination alone. At surgery, an obturator hernia was found in three cases. In the other two cases, no hernia was found. One patient had a pre-operative computed tomography, which showed an obturator hernia confirmed at surgery.
  
  
  CONCLUSIONS
  Computed tomography would be recommended in cases of diagnostic uncertainty. It may avoid unnecessary surgery in the elective setting and allow a focused procedure in the emergency setting. Laparoscopic repair is feasible in the emergency and elective setting with excellent results.
authors: Specialist Trainee General Surgery, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK Duncan.light@hotmail.co.uk.
authors: Duncan
authors: D
authors: Light
authors: Core Trainee General Surgery, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK.
authors: Kasra
authors: K
authors: Razi
authors: Consultant General Surgeon, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK.
authors: Liam
authors: L
authors: Horgan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D017558:Elective Surgical Procedures; D005260:Female; D006553:Hernia, Obturator / Q000000981:diagnostic imaging* / Q000601:surgery; D059685:Herniorrhaphy / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D013222:State Medicine; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Obturator hernia; computed tomography