A Case of Recurrent Bilateral Obturator Hernias after Mesh Plug Hernioplasty

Satoru Kawai, Hidetaka Yamanaka, Takahiko Ishizaka, Yasushi Kito, Hiroyuki Matunaga, Haruru Asamoto, Satoaki Kamiya and Yasutaka Matuzaki

Department of Surgery, Tsushima City Hospital

We report the first case, to our knowledge, of recurrent bilateral obturator hernias after mesh plug hernioplasty. An 85-year-old woman admitted for lower left abdominal pain and vomiting who had undergone laparotomy and mesh plug hernioplasty for bilateral obturator hernias two years earlier was found in abdominal computed tomography (CT) to have a dilated small intestine and intestine incarcerated between the bilateral pectineal muscle and external obturator muscle. Emergency surgery under a diagnosis of bowel obstruction due to obturator hernia showed dilation of the small intestine and focal redness, with dilated bilateral obturator foramens and indurations thought to be mesh plugs palpable bilaterally. Recurrent obturator hernias apparently were caused by mesh plug contraction. On the right side, the hernia sac was reversed and cut off and the mesh plug excised. The right obturator foramen was covered with mesh sheet. The hernia sac on the left side could not be reversed, so the hernia orifice was repaired with a direct peritoneal suture and covered with part of the bladder. The postoperative course was uneventful and the woman was discharged two weeks postoperatively. In mesh plug hernioplasty for an obturator hernia, it is important to keep in mind the possibility of recurrence caused by mesh plug contraction.

Key words
obturator hernia, mesh plug, recurrence

Reprint requests
Satoru Kawai Department of Surgery, Tsushima City Hospital
3-73 Tachibana-cho, Tsushima, 496-8537 JAPAN

Accepted
May 27, 2009

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