An obturator hernia passes through the obturator canal and is six times more frequent in women than in men, with most patients over sixty years of age. It is associated with the highest mortality rate of all abdominal hernias at 13 to 40%.
The hernia presents as small bowel obstruction with cramping abdominal pain and vomiting. The hernia may be felt as a tender swelling in the region of the obturator foramen on vaginal or rectal examination. The most specific finding is a positive Howship-Romberg sign. However, this is present in less than half of the cases and diagnosis should be suspected in any elderly debilitated woman without previous abdominal operations who presents with small bowel obstruction. CT scan will confirm the diagnosis.
The hernia is treated by stretching the obturator fascia and reducing the hernial sac into the peritoneal cavity. Recurrence is prevented by stitching the broad ligament over the opening.
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