Obturator hernia is an unsuspected diagnosis.
BACKGROUND
We present 6 patients with obturator hernia, from Harbor-UCLA Medical Center and Natalspruit Hospital, South Africa, bringing the total in the English literature to 676. This study was undertaken to examine the pitfalls in diagnosis and methods of treatment of this highly fatal condition.


METHODS
All patients were women, with an average age of 79 years. All were emaciated and in poor general condition, with dementia (4 patients), airway disease (3), cardiac disease (3), and disseminated carcinoma (1). For 5 of the 6 patients, the diagnosis was made at laparotomy. One patient died postoperatively.


RESULTS
The diagnosis was made from a lump in the upper thigh, felt vaginally or rectally, and a positive Howship-Romberg and/or a Hannington-Kiff sign. Radiographs, contrast studies, computed tomography scans, and herniography are helpful in making a diagnosis. In an emergency situation, lower midline laparotomy is preferred. Electively, other procedures and laparoscopic repair may be performed.


CONCLUSIONS
Mortality (10% to 50%) is common due to the poor condition of the patients and the delay in diagnosis. Earlier diagnosis may lower the high morbidity and mortality associated with this condition.
Naude
G
G
Department of Surgery, University of California, Los Angeles, School of Medicine, Harbor-UCLA Medical Center, Torrance 90509, USA.
Bongard
F
F
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006553:Hernia, Obturator / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D006801:Humans; D007813:Laparotomy