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参考文献：閉鎖孔ヘルニア
１）Surgery. 1996 Feb;119(2):137-40.
Obturator hernia: the usefulness of computed tomography in diagnosis.
Ijiri R, Kanamaru H, Yokoyama H, Shirakawa M, Hashimoto H, Yoshino G.
BACKGROUND. Delay in diagnosis and treatment of the rare obturator hernia often leads to high resection and mortality rates. Reviews of the clinical courses and the reliability of computed tomography (CT) in early diagnosis are reported. METHODS. Seventeen patients with obturator hernias were treated between April 1983 and December 1994. Except for one man, all were emaciated women who had undergone an average of 4.7 live deliveries. The mean age was 79.9 years. RESULTS. All patients had small bowel obstruction symptoms. Howship-Romberg sign was present in 11 patients. Twelve cases were correctly diagnosed before operation. After the introduction of CT in the diagnosis of suspected hernia cases, preoperative diagnosis was made on 9 of the 10 patients (90%) and CT was performed on 8 patients with 100% accuracy. CONCLUSIONS. Definite and early diagnosis is possible with the awareness of the clinical courses of this hernia and by performing CT on suspected cases.PMID: 8571197
２）Am J Surg. 2004 Apr;187(4):549-52.
Forty-three cases of obturator hernia.
Kammori M, Mafune K, Hirashima T, Kawahara M, Hashimoto M, Ogawa T, Ohta H, Hashimoto H, Kaminishi M.
BACKGROUND: Obturator hernia is a relatively rare pelvic hernia and usually occurs in elderly, thin, multiparous women. Because symptoms are nonspecific, the diagnosis is often delayed until laparotomy is performed form to treat bowel obstruction. METHODS: Forty-three patients with obturator hernia undergoing surgery at Tokyo Metropolitan Geriatric Hospital were divided retrospectively into two groups (group A = 23 patients from 1968 to 1986 before computed axial tomography [CAT] was developed; group B = 20 patients from 1987 to 1999 after CAT). Preoperative diagnosis, operative procedures, and postoperative course were reviewed and compared between the 2 groups. RESULTS: Preoperative diagnostic accuracy was significantly higher in group B at 80.0% (16 of 20 patients) than in group A at 43.5% (10 of 23 patients) (P = 0.0146). Rate of gut resection and mortality were significantly lower in group B at 25.0% (4 of 20) and 5.0% (1 of 20) than in group A at 52.2% (12 and 23) and 30.4% (7 of 23) (P = 0.0295 and P = 0.0385, respectively). CONCLUSIONS: The use of pelvic CAT in cases of suspected obturator hernia significantly enhances preoperative diagnostic accuracy and helps to decrease both intestinal resection rate and surgical mortality.PMID: 15041510
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