Dünndarmileus durch Obturatorhernie

Small bowel
obstruction secondary to obturator hernia. Semiupright, plain abdominal radiograph shows centrally located dilated small bowel loops. No evidence of free air is noted.
www.eurorad.org • CC by-nc-sa-4.0
Small bowel
obstruction secondary to obturator hernia. Supine plain abdominal radiograph shows centrally located dilated small bowel loops. Absence of rectal gas is also noted.
www.eurorad.org • CC by-nc-sa-4.0
Small bowel
obstruction secondary to obturator hernia. Axial plain CT shows left obturator hernia with a small bowel loop herniating through the left obturator foramen between the left pectineus and adductor longus muscles. Minimal fat stranding is seen surrounding the hernia sac.
www.eurorad.org • CC by-nc-sa-4.0
Small bowel
obstruction secondary to obturator hernia. Coronal plain CT shows left obturator hernia with a small bowel loop herniating through the left obturator foramen between the left pectineus and adductor longus muscles. Minimal fat stranding is seen surrounding the hernia sac.
www.eurorad.org • CC by-nc-sa-4.0
Small bowel
obstruction secondary to obturator hernia. Sagittal plain CT shows left obturator hernia with a small bowel loop herniating through the left obturator foramen between the left pectineus and adductor longus muscles. Minimal fat stranding is seen surrounding the hernia sac.
www.eurorad.org • CC by-nc-sa-4.0
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Dünndarmileus durch Obturatorhernie

Obturatorhernie Radiopaedia • CC-by-nc-sa 3.0 • de

Obturator hernias (alternative plural: herniae) are characterized by bowel herniating between the obturator and the pectineus muscles. They are a rare type of abdominal hernia and can be a challenge to diagnose clinically.

Epidemiology

Typically obturator hernias occur in older women  or patients with chronically raised intra-abdominal pressure (e.g. ascites, COPD, chronic cough) . They can occur in pregnancy, due to relaxation of the pelvic peritoneum and a wider and more horizontal obturator canal .  It has been suggested that there is a female predominance with this type of hernia, and they occur in less than 0.04% of all hernias .

Clinical presentation

In general, obturator hernias are asymptomatic unless they :

Pathology

The obturator foramen is occluded by the obturator membrane, which is pierced anterosuperiorly by the obturator artery, vein and nerve. This neurovascular bundle then travels along a 2-3 cm oblique tunnel, the obturator canal. It is through this deficiency that an obturator hernia occurs. Presumably, due to the sigmoid colon on the left, these hernias are more common on the right .

The layers that the hernial neck passes through include:

The hernia will then lie superficial to obturator externus and deep and inferior to pectineus muscle.

The hernia may contain any of the following:

Radiographic features

The diagnosis is readily made on CT/MRI with either fluid or bowel able to be traced along the aforementioned course to lie in the medial upper thigh.

Signs of complication, including:

Treatment and prognosis

Treatment involves surgery and repair of the hernial orifice.

History and etymology

Howship-Romberg sign is named for the German neurologist, Moritz Heinrich Romberg (1795-1873) , and British surgeon John Howship (1781-1841) .

Differential diagnosis

If a hernia contains bowel or can be clearly traced through the obturator foramen, then there are very few alternative diagnoses.

If seen with ultrasound, it may be mistaken for a bursa or acetabular labral cyst.

Siehe auch:
Assoziationen und Differentialdiagnosen zu Dünndarmileus durch Obturatorhernie:
Dünndarmileus
bei inkarzerierter Schenkelhernie
Wikipedia • CC BY-SA 4.0
Dünndarmileus
bei inkarzerierter Leistenhernie
Wikipedia • CC BY-SA 4.0