Traumatic obturator foramen hernia. A rare aetiology of a rare condition: A case report.

Obturator hernias (OH) are rare, accounting for less than 0.05% of all hernias. The aetiology is usually attributed to chronically raised intra-abdominal pressure or cachexia with poor muscle mass. This case report describes a traumatic obturator hernia, an exceptionally rare aetiology of an already rare surgical condition. There are no previous reports of a traumatic obturator hernia in the current literature. This case reports upon the presentation, operative findings and management of a 48 year old male with abdominal and pelvic trauma following a motor bike collision. Laparotomy findings included a right sided traumatic incarcerated obturator foramen hernia with the comminuted pubic rami fracture trapping and piercing ileum within the hernia. In retrospect, the hernia was visible on CT scan. The hernia was repaired using biological mesh which was covered with adjacent peritoneum. As with much of trauma surgery, the management of this case required reliance on general principles and real time problem solving to address an issue not previously experienced by the operator, and not previously reported on in the current literature.

Subtotal resection of an intradural mature teratoma in an adult presenting with difficulty initiating micturition.

BACKGROUND: Teratomas are tumors comprised of tissues from all three germ layers. Teratomas within the spine are exceedingly rare especially in the absence of either spinal dysraphism, congenital abnormalities of the spine, spinal surgery, or history of lumbar punctures. Virchow was the first to describe this occurrence in the spine in 1863 and since then, only a handful of cases have been reported. CASE DESCRIPTION: A 41-year-old male presented with a longstanding history of difficulty initiating micturition and lower back pain with recent onset of saddle paraesthesia and bilateral leg pain. He did not have a history suggestive of spinal trauma nor congenital abnormalities. Neurological examination was unremarkable. Magnetic resonance imaging (MRI) confirmed the presence of an intradural extra axial lesion in the region of the cauda equine. At surgery, the lesion was found to be densely adherent to the conus and a subtotal resection was performed. Histological examination confirmed the lesion to be a mature teratoma. Postoperatively, he made a good recovery and there is no evidence of recurrence at one year follow-up. CONCLUSION: This case demonstrates that a teratoma without immature elements can be subtotally excised to reduce the risk of neurological morbidity.