title: Obturator hernia: A case report and review of the literature.
abstract: BACKGROUND
  An obturator hernia is a rare condition but is associated with the highest mortality of all abdominal wall hernias. Early surgical intervention is often hindered by clinical and radiological diagnostic difficulty. The following case report highlights these diagnostic difficulties, and reviews the current literature on management of such cases.
  
  
  METHODS
  We present the case of an 86-year-old lady who presented with intermittent small bowel obstruction, clear hernial orifices, and right medial thigh pain. Pre-operative CT imaging was suggestive of an obstructed right femoral hernia. However, intra-operatively the femoral canal was clear and an obstructed hernia was found passing through the obturator foramen lying between the pectineus and obturator muscles in the obturator canal.
  
  
  CONCLUSIONS
  Obturator hernias are notorious for diagnostic difficulty. Patients often present with intermittent bowel obstruction symptoms due to a high proportion exhibiting Richter's herniation of the bowel. Hernial sacs can irritate the obturator nerve within the canal, manifesting as medial thigh pain, and often no hernial masses can be detected on clinical examination. Increasing speed of diagnosis through early CT imaging has been shown to reduce the morbidity and mortality associated with obturator hernias. However, over-reliance on CT findings should be cautioned, as imaging and operative findings may not always correlate.
  
  
  CONCLUSIONS
  A high suspicion for obturator hernia should be maintained when assessing a patient presenting with bowel obstruction particularly where intermittent symptoms or medial thigh pain are present. Rapid clinical and appropriate radiological assessment, followed by early surgery is critical to successful treatment.
authors: General Surgery Department, South West Acute Hospital, 124 Irvinestown Road, Enniskillen BT74 6DN, United Kingdom. Electronic address: nickhodgins@googlemail.com.
authors: Nicholas
authors: N
authors: Hodgins
authors: Krzysztof
authors: K
authors: Cieplucha
authors: Padhraic
authors: P
authors: Conneally
authors: Essam
authors: E
authors: Ghareeb
keywords: Hernia; Obturator
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