Rare case of obturator hernia: Surgical anatomy, planning, and considerations

Abstract

Obturator hernia is a rare variation of abdominal hernias that cause significant morbidity and mortality, especially in the elderly population. Incidence rates vary but account for approximately 0.07%–1.0% of all hernias. Literature on laparoscopic versus laparotomy, as well as types of closure (primary vs mesh) have not been well described in the literature. Obturator hernias, although rare, require a high index of suspicion and care in surgical management as many of these patients will be elderly with a multitude of comorbid conditions. Further research and reporting on technique and type of closures utilized when these rare hernias are encountered by surgeons would benefit the surgical community on practices and management of obturator hernias. Here, we present a case of an elderly female who presented with complaints of obstructive symptoms and abdominal pain secondary to an obturator hernia.

Incarcerated obturator hernia with a fistula to the adductor muscles: Case report of a rare hernia with uncommon symptoms, discovered by CT

“…In slender older patients, this should also be considered in the context of hip pain. Contrast CT provides reliable evidence of a hernia [ 1 , 3 , [10] , [11] , [12] ]. An obturator hernia is a valid indication for surgical treatment if the patient's constitution allows it.…”

“…The diagnosis of an obturator hernia can be a challenge. It is a rarity accounting for 0.07–1 % among hernias [ [1] , [2] , [3] ]. Obturator hernias are most common in older and slim women [ 1 , 4 , 5 ].…”

Obturator hernia: An uncommon cause of intestinal obstruction: A case report

“…Mortality from obturator hernias has ranged from 8 % to 47 % in the literature [ 17 ]. In a retrospective study performed at a single institution from 2001 to 2010 that reviewed 21 patients with obturator hernias, the overall mortality among patients with OH was as high as 47.6 % [ 18 ].…”

Contemporary management of obturator hernia

“…Obturator hernia occurs when abdominopelvic contents enter the obturator canal, an osteofibrous passage within the obturator foramen (bordered by the ischiopubic rami at the anteroinferior pelvic margin). 1 Howship-Romberg sign—pain on ipsilateral thigh adduction and internal rotation due to obturator nerve compression—is only present in half of cases. 2 Most obturator hernias present with bowel obstruction and require emergency operative management; almost half require resection of strangulated bowel.…”