Obturator hernia: Anatomy, embryology, diagnosis, and treatment

Abstract

An obturator hernia is an infrequent but significant cause of intestinal obstruction. The incidence of obturator hernias is between 0.05 and 1.4% of all hernias. The mortality rate can be as high as 70% when acutely incarcerated due to the difficulty in diagnosis and delay in surgical treatment Three progressive stages of obturator herniation have been classified and can be one of three different varieties depending on the pathway the herniated sac follows. Knowledge of the anatomy and pathogenesis of obturator herniation is essential in diagnosis and treatment. The most common clinical presentation is intestinal obstruction (90%) and this is often seen in elderly, emaciated, multiparous women with predisposing conditions. Other classic signs, though not always present include obturator neuralgia, the Howship-Romberg sign and the Hannington-Kiff sign. Computed tomography scan is the most favored diagnostic imaging method. The abdominal surgical approach is most preferred when a diagnosis is uncertain and laparoscopy should be employed in elective early surgeries. This aim of this article is to review the diagnosis and treatment of obturator hernia by describing the anatomy, embryology, clinical presentation, diagnosis, and management currently in use. Increased awareness and proper management of this condition will result in decreased morbidity and mortality.

Challenging Management of Obturator Hernia: A Report of Three Cases And Literature Review

“…[5,6] Acute intestinal obstruction is the most significant clinical presentation, present in over 90% of OH patients. [2] Approximately half present with small-bowel strangulation. [7] In addition, OH may contain the large bowels, omentum, appendix, or fallopian tubes.…”

“…[8,9] Other clinical symptoms include lower abdominal pain, abdominal distention, nausea, vomiting, and obturator neuralgia, associated with intestinal ischemia, all of which are non-specific findings ranging from mild to severe. [2] Unfortunately, these symptoms in isolation are not sufficient for differential diagnosis.…”

“…Several surgical procedures have been described, including abdominal, inguinal, retropubic, and obturator approaches. [2] Inguinal, retropubic and obturator approaches are preferred when preoperative diagnosis is clear, and intestinal strangulation is excluded. The aims of surgical intervention should be to evaluate viability of incarcerated organs or intestines for adequate resection and to repair the corrupted obturator canal.…”

“…[1] Excessive weight loss and multi-parity in women, chronic obstructive pulmonary disease, increased intraabdominal pressure associated with chronic constipation, and ascites are risk factors for obturator canal enlargement leading to the development of peritoneal dimple and invagination of a peritoneal sac into the obturator canal. [2] Clinical characteristics of OH are obscure. Lack of significant examination findings and clinical symptoms usually increase rates of morbidity and mortality.…”

Concomitant obturator hernia and midgut volvulus in an elderly woman

“…It is also a rare cause of small bowel obstruction, accounting for 0.2-1.6% of bowel obstruction [1][2][3][4][5][6]. Obturator hernia may be associated with midgut volvulus [6].…”