Obturator hernia overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Yarlagadda Harshitha, MD[2]
Overview
An obturator hernia is a rare type of abdominal wall hernia in which abdominal content protrudes through the obturator foramen. Obturator foramen is a large, obliquely oriented opening, located at the anterior aspect of both sides of pelvis, bounded by parts of ischium and pubis. This hernia passes through the obturator foramen, following the path of the obturator nerve and blood vessels. Most commonly seen in elderly multiparous women. Obturator hernia must be differentiated from other causes of chronic pelvic pain and groin mass in elderly females. CT scan usually confirms the diagnosis of Obturator hernia. Surgery is the main stay of treatment. Morbidity and mortality associated with obturator hernia can be reduced with early diagnosis and prompt surgical intervention.
Historical Perspective
The Obturator hernia was first described by Pierre Roland Arnaud de Ronsil, at the Royal Academy of sciences in 1724. It is a rare condition and by 1980 only 541 cases have been reported in the literature. First successful operation was performed by Obre in 1851.
Pathophysiology
Obturator foramen is a large, obliquely oriented opening, located at the anterior aspect of both sides of pelvis, bounded by parts of ischium and pubis. This hernia passes through the obturator foramen, following the path of the obturator nerve and blood vessels. Contents of the Hernial sac in Obturator hernia include Ileum, appendix, omentum, peritoneum. Most commonly seen content of the hernial sac is ileum. Obturator hernias are more common on the right, presumably due to sigmoid colon on the left.
Causes
Exact reason of obturator hernia is unknown. Possible reasons involve the natural aging process. As adults age, the body loses muscle mass and fatty tissue. Sudden weight loss and malnutrition can have the same effect.
Differentiating obturator hernia from other diseases
Obturator hernia must be differentiated from other causes of chronic pelvic pain and groin mass in elderly females.
Epidemiology and Demographics
Obturator hernia is a rare hernia accounting for less than 1% of all intra abdominal hernias. Most common in elderly multiparous women. Obturator hernia can also be seen in conditions with chronically raised intra abdominal pressure like ascites, COPD, chronic cough.
Risk Factors
Risk factors include natural aging process, sudden weight loss, malnutrition and Conditions which increase intra abdominal pressure like Chronic pulmonary disease, Ascites and chronic Constipation.
Natural History, Complications, and Prognosis
Obturator hernia is a rare hernia accounting for less than 1% of all intra abdominal hernias. Morbidity and mortality associated with obturator hernia can be reduced with early diagnosis and prompt surgical intervention. Obturator hernia should be strongly suspected in an elderly woman with small bowel obstruction and Obturator neuralgia.
Diagnosis
CT scan may be considered as the most valuable study to establish a pre operative diagnosis. Findings on Computed Tomography scan of Obturator hernia include small bowel dilation and Strangulation.
Treatment
Surgery is the main stay of treatment for Obturator hernia. As symptoms are nonspecific, pre-operative diagnosis is difficult. CT scan of the abdomen and pelvis or Laparotomy should be performed immediately when the diagnosis is in doubt. As, high mortality is associated with bowel perforation.