Special Consideration:The Obturator Hernia

George Ferzli MD, FACS

Staten Island University Hospital

Staten Island, New York

Obturator Hernia• 1724 - described by Arnaud de Ronsil

• 1851 - First repair by Henry Obre

• Approximately 0.1% of all hernias

Obturator Hernia• 9 : 1 female to male ratio

• Typical patient is > 70 yrs of age

• “Little old lady’s hernia”

• Up to 20% bilateral

• Intestinal obstruction– most common presentation

• Up to 70% mortality with strangulation

CLINICAL PRESENTATION

CLINICAL PRESENTATION

• Howship-Romberg

– Pain in medial thigh with extension, abduction, and medial rotation of the hip

– Pathognomonic but rarely found

• Hernia is not palpable externally

ANATOMY• Formed by rami of the ischium and

pubis

• Bilaterally in anterolateral pelvic wall

• Inferior to the acetabulum

Obturator Foramen

• Covered by obturator membrane

• Internal orifice closed by preperitoneal fat

• Contains obturator nerve and vessels

Obturator Foramen

MRI

CT SCAN

TAPP

INCARCERATED - TEP

STRANGULATED - TEP

SUMMARY• Obturator hernia can be repaired

laparoscopically

• Bilateral inspection is mandatory

• Bowel viability must be assessed

• Mesh repair can be performed

QUESTION Should prosthetic mesh be

used in the presence of intestinal perforation ?