Obturator hernia

Obturator hernia is a rare type of hernia that occurs when tissue or a part of the intestine protrudes through the obturator foramen, a small opening in the pelvic bone. This condition is more common in elderly, thin, and female patients, and is often associated with significant morbidity and mortality due to delayed diagnosis.

Causes

The primary cause of an obturator hernia is increased intra-abdominal pressure, which can be due to pregnancy, obesity, chronic cough, constipation, or ascites. Other factors that can contribute to the development of this condition include a large obturator canal, loss of preperitoneal fat, and a mobile cecum.

Symptoms

The symptoms of an obturator hernia can be non-specific and may include abdominal pain, nausea, vomiting, and obstipation. In some cases, a mass may be palpable in the medial thigh or groin. The Howship-Romberg sign, characterized by pain along the medial aspect of the thigh, is a classic sign of obturator hernia but is present in less than half of the cases.

Diagnosis

Diagnosis of an obturator hernia can be challenging due to its non-specific symptoms and rarity. Computed tomography (CT) scan is the most reliable diagnostic tool, with a sensitivity of up to 80%. Other diagnostic methods include ultrasound, magnetic resonance imaging (MRI), and exploratory laparotomy.

Treatment

The treatment of choice for an obturator hernia is surgical repair, either through an open or laparoscopic approach. The choice of procedure depends on the patient's overall health, the size of the hernia, and the surgeon's experience. In some cases, a bowel resection may be necessary if the hernia has caused strangulation of the intestine.

Prognosis

The prognosis of an obturator hernia largely depends on the timeliness of diagnosis and treatment. With prompt surgical intervention, the prognosis is generally good. However, delayed diagnosis and treatment can lead to complications such as bowel obstruction and strangulation, which can be life-threatening.

See also

• Hernia
• Inguinal hernia
• Femoral hernia
• Umbilical hernia
• Incisional hernia

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