title: Obturator hernia: the Mayo Clinic experience.
abstract: BACKGROUND
  Obturator herniae (OH) are rare, with nonspecific signs and symptoms, and diagnosis is usually delayed until laparotomy. The added benefit of preoperative diagnosis with computed tomography (CT) remains unclear.
  
  
  METHODS
  We reviewed the clinical characteristics and outcomes of OH repairs performed at our institution over a 58-year period. Outcomes were compared between patients who did or did not have a preoperative CT.
  
  
  RESULTS
  Between 1950 and 2008, 30 patients (median age 82 years, 29 women) underwent OH repair. The most common presenting signs and symptoms were bowel obstruction (63%), abdominal/groin pain (57%), and a palpable lump (10%). The pathognomonic Howship-Romberg sign was present in 11 patients (37%). The diagnosis was made preoperatively in nine patients: clinically in one (3%) and with CT in eight (27%). Nineteen patients (63%) presented emergently. Primary and prosthetic repair were performed in 23 (77%) and seven (23%) patients, respectively. Small-bowel resection was performed in 14 patients (47%). Perioperative morbidity (30%) and mortality (10%) rates were high. Patients with a preoperative CT were less likely to develop a postoperative complication of any type [odds ratio (OR) 0.8, P = 0.04]; however, time to operation, length of stay, need for bowel resection, and mortality rate did not differ (P = NS). No recurrences were detected at a median follow-up of 2 years (range 0-55).
  
  
  CONCLUSIONS
  Although CT imaging provides an excellent means of preoperative diagnosis, suggestive signs and symptoms in a "skinny old lady" should prompt immediate operative intervention without delay.
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: B S
authors.initials: BS
authors.lastname: Nasir
authors.forename: B
authors.initials: B
authors.lastname: Zendejas
authors.forename: S M
authors.initials: SM
authors.lastname: Ali
authors.forename: C B
authors.initials: CB
authors.lastname: Groenewald
authors.forename: S F
authors.initials: SF
authors.lastname: Heller
authors.forename: D R
authors.initials: DR
authors.lastname: Farley
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D005260:Female; D006553:Hernia, Obturator / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology*; D007421:Intestine, Small / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011300:Preoperative Care; D012189:Retrospective Studies; D012737:Sex Factors; D013851:Thinness / Q000150:complications; D013997:Time Factors; D014057:Tomography, X-Ray Computed