Richterov tip inkarcerirane obturatorne hernije: otežana dijagnostika

Obturator hernia is a rare type of abdominal hernia where herniation occurs through the obturator canal. It develops predominantly in elderly underweight women. It has unspecific early symptoms, which is the reason these hernias are usually discovered only after they have become incarcerated. Incarcerated obturator hernias are usually discovered on abdominal computed tomography (CT) scan or emergency surgery due to bowel obstruction. We present a case of an 85-year-old female patient who was admitted because of intermittent abdominal pain and vomiting. Consecutive upright abdominal x-rays failed to show bowel obstruction. Abdominal CT scan revealed a right-sided incarcerated femoral hernia that was not found during emergency surgery. After laparotomy had been performed, a Richter type of right-sided incarcerated obturator hernia was discovered with a small necrotic area on the small bowel. Bowel resection was performed and obturator hernia was closed with interrupted sutures. The patient recovered without complications. Obturator hernia, due to its rarity and unspecific early symptoms, can still be misleading even to the most experienced surgeons. Delayed diagnosis of obturator hernia can lead to bowel necrosis and perforation with significant postoperative morbidity and mortality.Obturatorna hernija je rijedak oblik abdominalne hernije gdje do hernijacije dolazi kroz obturatorni kanal. Najčešće se javlja kod starijih pothranjenih žena. Rani simptomi obturatorne hernije su nespecifični, što je razlog da se ovakve hernije prepoznaju obično nakon što se razvije inkarceracija. Inkarcerirane obturatorne hernije se najčešće prepoznaju tijekom CT trbuha ili hitnog kirurškog zahvata zbog simptoma mehaničkog ileusa. Ovdje prikazujemo slučaj 85-godišnje bolesnice koja je primljena u bolnicu zbog povremenih bolova u trbuhu praćenih povraćanjem. Uzastopne nativne RTG snimke abdomena nisu pokazale opstrukciju crijeva. Učinjen je CT trbuha gdje se prikazala desnostrana inkarcerirana femoralna kila koja, međutim, tijekom hitnog kirurškog zahvata nije nađena. Nakon što je učinjena laparotomija, pronašli smo desnostranu inkarceriranu obturatornu kilu Richterova tipa s malim područjem nekrotičnog tankog crijeva. Učinili smo segmentnu resekciju tankog crijeva. Kilni otvor je zatvoren pojedinačnim šavima. Postoperacijski oporavak bolesnice je bio uredan. Obturatorna kila, zahvaljujući niskoj incidenciji i nespecifičnim ranim simptomima, može biti zbunjujuća čak i za najiskusnijeg kirurga. Odgođena dijagnoza obturatorne kile može dovesti do nekroze i perforacije crijeva, što sa sobom nosi značajan pobol i smrtnost