Obturator hernia

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Yarlagadda Harshitha, MD[2]

An obturator hernia is a rare type of abdominal wall hernia in which abdominal content protrudes through the obturator foramen. Obturator foramen is a large, obliquely oriented opening, located at the anterior aspect of both sides of pelvis, bounded by parts of ischium and pubis. This hernia passes through the obturator foramen, following the path of the obturator nerve and blood vessels. Most commonly seen in elderly multiparous women. Obturator hernia must be differentiated from other causes of chronic pelvic pain and groin mass in elderly females. CT scan usually confirms the diagnosis of Obturator hernia. Surgery is the main stay of treatment. Morbidity and mortality associated with obturator hernia can be reduced with early diagnosis and prompt surgical intervention.

The Obturator hernia was first described by Pierre Roland Arnaud de Ronsil, at the Royal Academy of sciences in 1724. It is a rare condition and by 1980 only 541 cases have been reported in the literature. First successful operation was performed by Obre in 1851.

Obturator foramen is a large, obliquely oriented opening, located at the anterior aspect of both sides of pelvis, bounded by parts of ischium and pubis. This hernia passes through the obturator foramen, following the path of the obturator nerve and blood vessels. Contents of the Hernial sac in Obturator hernia include Ileum, appendix, omentum, peritoneum. Most commonly seen content of the hernial sac is ileum. Obturator hernias are more common on the right, presumably due to sigmoid colon on the left.

Exact reason of obturator hernia is unknown. Possible reasons involve the natural aging process. As adults age, the body loses muscle mass and fatty tissue. Sudden weight loss and malnutrition can have the same effect.

Obturator hernia must be differentiated from other causes of chronic pelvic pain and groin mass in elderly females.

Obturator hernia is a rare hernia accounting for less than 1% of all intra abdominal hernias. Most common in elderly multiparous women. Obturator hernia can also be seen in conditions with chronically raised intra abdominal pressure like ascites, COPD, chronic cough.

Risk factors include natural aging process, sudden weight loss, malnutrition and Conditions which increase intra abdominal pressure like Chronic pulmonary disease, Ascites and chronic Constipation.

Obturator hernia is a rare hernia accounting for less than 1% of all intra abdominal hernias. Morbidity and mortality associated with obturator hernia can be reduced with early diagnosis and prompt surgical intervention. Obturator hernia should be strongly suspected in an elderly woman with small bowel obstruction and Obturator neuralgia.

CT scan may be considered as the most valuable study to establish a pre operative diagnosis. Findings on Computed Tomography scan of Obturator hernia include small bowel dilation and Strangulation.

Surgery is the main stay of treatment for Obturator hernia. As symptoms are nonspecific, pre-operative diagnosis is difficult. CT scan of the abdomen and pelvis or Laparotomy should be performed immediately when the diagnosis is in doubt. As, high mortality is associated with bowel perforation.

• The Obturator hernia was first described by Pierre Roland Arnaud de Ronsil, at the Royal Academy of sciences in 1724.
• First successful operation was performed by Obre in 1851.
• It is a rare condition and by 1980 only 541 cases have been reported in the literature.^[1]
• Howship-Romberg sign is named for John Howship and Mortiz Heinrich Romberg.^[2]
• In 1980, John G Hannington-Kiff described Hannington-Kiff sign.^[3].

The following are a few famous cases of [disease name]:

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Yarlagadda Harshitha, MD[2]

• Obturator foramen is a large, obliquely oriented opening, located at the anterior aspect of both sides of pelvis, bounded by parts of ischium and pubis.
• This hernia passes through the obturator foramen, following the path of the obturator nerve and blood vessels.
• Hernia passes through the following layers
  • Obturator internus muscle fibres
  • Obturator membrane
  • Obturator externus muscle fibres
• Obturator hernias are more common on the right, presumably due to sigmoid colon on the left.

• Contents of the Hernial sac in Obturator hernia^[1][2]
  • Ileum – most common
  • appendix
  • Omentum
  • Peritoneum

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Exact reason of obturator hernia is unknown. Possible reasons involve the natural aging process. As adults age, the body loses muscle mass and fatty tissue. Sudden weight loss and malnutrition can have the same effect.^[1]

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Obturator hernia must be differentiated from other conditions that cause chronic pelvic pain and groin mass in elderly females.

Various differential diagnosis of obturator hernia include^[1]

• Small bowel obstruction
• malignancy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

• Most common in older women.
• Commonly called as ‘Little old lady’s hernia’.^[1]

• More common in females due to^[2]
  • wider pelvis
  • more triangular obturator canal opening
  • greater transverse diameter.
• Usually occurs in elderly and multiparous women.

• Obturator hernia can also be seen in conditions with chronically raised intra abdominal pressure like ascites, COPD, chronic cough.
• Can be seen in pregnant women due to relaxation of pelvic peritoneum, and a wider and more horizontal obturator canal.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

• Natural aging process.
• Sudden weight loss.
• Malnutrition.
• Conditions which increase intra abdominal pressure like Chronic pulmonary disease, Ascites and chronic Constipation.^[1]

Obturator hernia is a rare hernia accounting for less than 1% of all intra abdominal hernias. Morbidity and mortality associated with obturator hernia can be reduced with early diagnosis and prompt surgical intervention.

• Obturator hernia is a rare hernia accounting for less than 1% of all intra abdominal hernias.^[1]
• Clinical diagnosis is considered challenging as symptoms are nonspecific.
• Obturator hernia should be strongly suspected in an elderly woman with small bowel obstruction and Obturator neuralgia.^[2]
• Obturator hernia should be included in the elderly women with chronic pelvic pain.
• Morbidity and mortality associated with Obturator hernia can be reduced with early diagnosis and prompt surgical intervention.^[3]

• Common complications of obturator hernia include^[4]
  • Bowel obstruction
  • Strangulation or Incarceration
  • Perforation
  • Bowel Ischemia

• Laproscopic approach has lower post-operative complication rates when compared to open laparotomy in stable patients.^[5]
• Obturator hernias carry significant morbidity and mortality which can be reduced with early diagnosis and surgical intervention.^[6]