Obturator hernia: a continuing diagnostic challenge.
BACKGROUND
The rare obturator hernia has a high incidence of potentially lethal complications. This report reviews this condition and stresses the dangers of unrecognized obturator hernia.


METHODS
Thirteen patients with 14 obturator hernias were seen during a 5-year period. All the patients were emaciated and elderly, and 12 were women. They all had clinical features of small bowel obstruction. The classic Howship-Romberg sign was present in only three patients. The diagnosis was made before surgery in five patients.


RESULTS
All hernial sacs contained small bowel. Ileum were present in 11 instances. Richter-type hernia was present in 10 cases. Bowel resection for gangrenous loop was required in seven instances. Apart from associated poor medical conditions, delay in presentation and operation also contributed to the high morbidity and mortality rates. Five patients (38.5%) had postoperative complications, and two patients (15.4%) died of chest infections.


CONCLUSIONS
The need for awareness of the condition is stressed and the diagnosis of obturator hernia should be strongly suspected in a thin, elderly woman who has small bowel obstruction and no previous abdominal surgery.
Yip
A W
AW
Department of Surgery, Kwong Wah Hospital, Kowloon, Hong Kong.
AhChong
A K
AK
Lam
K H
KH
D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D006553:Hernia, Obturator / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D008297:Male; D016896:Treatment Outcome