Case report: Obturator hernia: Diagnosis and surgical treatment

Abstract

BackgroundObturator hernia (OH) is a rare external abdominal hernia, accounting for only 0.07%–1% of all hernia cases. Because the female pelvis is wider and there is less preperitoneal adipose tissue, the obturator canal is larger, which can lead to herniation of abdominal contents when abdominal pressure increases in elderly women with thin body. The clinical symptoms of patients with obturator hernia included abdominal pain, nausea, vomiting, etc., and the mass in the inguinal region could not be touched. The positive Howship-Romberg sign is a specific sign of OH. CT is the first choice for the diagnosis of obturator hernia. Since intestinal incarceration in OH patients is prone to lead to intestinal necrosis, emergency surgical treatment is often required. However, due to the lack of specificity of its clinical manifestations, the misdiagnosis rate is high, which often leads to the delay of diagnosis and treatment.MethodsWe report the case of an 86-year-old woman with a thin body and a history of multiple deliveries. The patient presented with abdominal pain, bloating, and constipation for 5 days. Physical examination revealed a positive Howship-Romberg sign on the right side, and CT examination suggested intestinal obstruction. Therefore, an urgent exploratory laparotomy was performed.ResultsAfter opening the abdominal cavity we found that the wall of the ileum was embedded in the right obturator, and the proximal bowel was significantly dilated. We restored the embedded bowel wall to its original position, resected the necrotic bowel and performed an end-to-end anastomosis of the small intestine. The right hernia orifice was sutured, and OH was diagnosed during the operation.ConclusionThis article summarizes the diagnosis and treatment of OH by sharing this case, so as to provide a more detailed plan for early diagnosis and treatment of OH.

Multiple Complicated Concurrent Hernias in a Single Patient: A Case Report

“…The most common signs and symptoms of obturator hernia include bowel obstruction, abdominal pain, groin pain, and a palpable groin mass [12]. Patients may also have the Howship-Romberg sign, associated with inner thigh pain when internally rotating the hip; and the Hannington-Kiff sign; characterized by loss of adductor reflexes [15]. However, clinical symptoms are rarely sufficient and specific to confirm the diagnosis.…”

Intestinal Obstruction Due to an Incarcerated Obturator Hernia: A Case Report and Review of the Literature

“…There are incidences of delayed intestinal necrosis due to incarcerated intestinal obstruction. The intestinal resection rate in OH is 25%-50% because of the development of gangrene [ 15 ]. In the presence of intestinal obstruction or perforation and severe comorbidities, an emergency laparotomy should be performed through a midline incision.…”

Case report: Incarcerated obturator hernia, initially presenting as right hip pain!

“…The obturator nerve enters the obturator canal above the accompanying arteries and veins, and passes through the obturator canal. It was divided into anterior and posterior segments to innervate the adductor muscle group and the ipsilateral hip and knee joints, respectively [ 1 ].…”

“…This case is important and differs from the well-known similar cases through the emergency admission at the orthopedic department because of the clear right hip pain and clinical history from the patient. An Obturator herniation (OH) is a rare external abdominal hernia accounting for only 0.07 %–1 % of all hernia cases [ 1 ]. Because the female pelvis is wider which can lead to herniation of abdominal contents [ 1 ].…”

“…An Obturator herniation (OH) is a rare external abdominal hernia accounting for only 0.07 %–1 % of all hernia cases [ 1 ]. Because the female pelvis is wider which can lead to herniation of abdominal contents [ 1 ]. CT-Scanning is the first choice for the diagnosis of an obturator hernia [ 2 ].…”