An external abdominal hernia that protrudes from the abdominal organs to the femoral triangle through the obturator is called an obturator hernia. Obturator hernias are rare, less than 0.07% of all external abdominal hernias. Obturator hernia generally occurs in elderly female patients who are wasting and have multiple births, so it is also called "little old lady's hernia" in the literature.
The obturator is a pair of large oval holes formed by the combination of the pubic and ischial branches from the pelvic cavity to the thigh. The obturator is closed by the obturator membrane, but there is a thin tube with nerves and blood vessels passing through the tube.
The obturator hernia is located in the deep layer of the pubic muscle, the lower end of the femoral triangle, above the obturator muscle, between the pubic muscle and the adductor longus muscle.
1.diagnosis
The patient presents with pain on the inner thigh, which can be relieved in flexion, and the pain is aggravated during hyperextension, adduction or internal rotation. Due to the inaccessibility of hernia masses, the lack of specific symptoms and typical masses like other abdominal wall hernias (such as inguinal hernias), and most surgeons have little experience in receiving such patients, the preoperative diagnosis of obturator hernias is often More difficult, most of them are diagnosed intraoperatively.
Howship-Romberg sign (HR) is the early and most characteristic sign of obturator hernia, and it is also the main basis for making a diagnosis before surgery. This disease should be considered when frail and elderly women have intestinal obstruction and HR signs. However, the specificity of HR is not high. When a patient has HR signs, it does not mean that they are all obturator hernias, and patients diagnosed with obturator hernias do not necessarily have HR signs.
2.treatment
The traditional method is open surgery, which has relatively high complications and mortality. In recent years, with the development of laparoscopic technology, the application of laparoscopic obturator hernia surgery can achieve more satisfactory results. However, in patients with acute intestinal obstruction, open surgery is recommended. Therefore, patients with obturator hernia need individualized treatment.
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