Acute intestinal obstruction, difficulties in diagnosis in starged hernias of the opturate forana and surgical tactics

Relevance. Hernias of the obturator canal are extremely rare in surgical practice. This type occurs in 0.07% to 1% of all known hernias, in which the contents of the pelvic or abdominal organs penetrate through the obturator foramen. The hernias in question occur predominantly in elderly women of low nutrition with a large history of childbirth. This is explained by the peculiarities of the anatomical structure of the female pelvis: its pronounced slope, the larger size of the obturator foramen, the more vertical position of the obturator canal compared to the male, and the weakness of the pelvic floor muscles. Diagnosing an obturator hernia is very difficult. Being difficult to diagnose cases, strangulated hernias of the obturator canal are detected at the treatment stage and are accompanied by high mortality. Mortality for these manifestations ranges from 12% to 70%, with postoperative measurements in 11.6% of cases. These statistics provide the majority of observations provided by reputable Japanese colleagues [3]. Conclusions. Hernias of the obturator foramen, due to their rare occurrence and lack of clear clinical manifestations, are difficult diagnostic cases. Knowledge of the symptoms characteristic of this pathology, the use of computed tomography of the abdominal cavity and pelvis with contrast enhancement is extremely important, influencing the adoption of a reliably correct, quick decision for surgical intervention, largely determining the outcome of the disease. Specific diagnostics for determining obturator foramen hernia are not covered in clinical recommendations. Due to the fact that this clinical pathology is quite complex for a surgeon to quickly determine, it is detected at the stage of complications and is accompanied by high mortality. The leading clinical picture for a strangulated hernia of the obturator foramen is signs of intestinal obstruction. Correctly and timely preoperative diagnosis is crucial for the surgeon to decide on tactics. In the case of a clinical picture of intestinal obstruction, one should act on the basis of national clinical recommendations, not forgetting to manually check the location of the hernia, which will significantly reduce the time for diagnostic searches and reduce postoperative mortality in case of a strangulated hernia of the obturator foramen.

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