title: Obturator hernia: the relationship between anatomical classification and the Howship-Romberg sign.
abstract: BACKGROUND
  The obturator hernia sac may follow the anterior or posterior branch of the obturator nerve, and thus, it can be classified anatomically. The relationship between the symptoms and the anatomical classification of obturator hernia has not yet been clearly described in the literature.
  
  
  METHODS
  Multidetector-row computed tomography (MDCT) examinations of 35 consecutive cases of new-onset obturator hernia admitted from March 2005 to April 2012 were reviewed retrospectively. Obturator hernia was classified anatomically using MDCT. Patient characteristics and clinical presentations were compared among the anatomical classifications.
  
  
  RESULTS
  Fifteen cases were classified as type I (anterior branch type) and 20 cases as type II (posterior branch type). There were no significant differences regarding time from onset of symptoms to diagnosis, presence of small bowel obstruction, and need for bowel resection. The Howship-Romberg sign was seen in 6 cases (30 %) of type II and 10 cases (67 %) of type I (p = 0.044).
  
  
  CONCLUSIONS
  The Howship-Romberg sign was present significantly more often with the anterior than the posterior branch type of obturator hernia.
authors.affiliation: Department of Surgery, Asahi General Hospital, I-1326, Asahi, Chiba, 289-2511, Japan, tak.karasaki@gmail.com.
authors.forename: T
authors.initials: T
authors.lastname: Karasaki
authors.forename: T
authors.initials: T
authors.lastname: Nakagawa
authors.forename: N
authors.initials: N
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006553:Hernia, Obturator / Q000145:classification* / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D010808:Physical Examination; D012189:Retrospective Studies