Obturator hernia: A diagnostic challenge

Abstract

Patient: Female, 90Final Diagnosis: Obturator herniaSymptoms: Epigastric pain • vomitingMedication: —Clinical Procedure: —Specialty: Gastroenterology and HepatologyObjective:Challenging differential diagnosisBackground:Obturator hernia (OH) can be difficult to diagnose because it shows only nonspecific signs and symptoms. Although pain in a lower limb caused by compression of the obturator nerve by the hernia in the obturator canal (Howship-Romberg sign) is a characteristic sign, its presence is rather rare.Case Report:We herein describe the case of a 90-year-old woman with an OH that was difficult to diagnose because of her slight abdominal signs and symptoms on admission and subtle abdominal computed tomography (CT) findings. Although the CT images revealed the presence of an OH, this finding was overlooked because it contained only a part of the small intestine wall, which is called the Richter type. Fortunately, her condition improved dramatically with only conservative treatment.Conclusions:Although early diagnosis is essential to reduce morbidity and mortality, OH can be a diagnostic challenge even with abdominal CT.

Richter’s Type of Incarcerated Obturator Hernia that Presented with a Deep Femoral Abscess: An Autopsy Case Report

“…A CT scan is more useful for making a definitive and preoperative diagnosis of OH, with sensitivity and accuracy superior to those of ultrasonography or herniography [4]. Diagnosis of OH can be still difficult even with abdominal CT when clinical signs and symptoms are subtle [10]. First-choice treatment of OH is a herniorrhaphy via laparotomy.…”

Emergency incarcerated obturator hernia repair with biologic mesh in a male patient after ipsilateral hip disarticulation: A case report

“…The Howship–Romberg sign is a maneuver involving internal rotation of the lower extremity producing pain in the obturator region, and while it is specific to obturator hernias, it only appears in 15–52% of cases [4] . Computerized Tomography (CT) scans (90% sensitivity) are essential; however, only exploratory laparoscopy provides definitive visualization of herniation [5] . Due to the furtive nature of obturator hernias, they have the highest mortality rates of ventral wall hernias, ranging from 13 to 40% if a strangulated hernia is not treated timely [6] .…”