Obturator Hernia: diagnosis and management under conditions of limited resources

Abstract

Background: Obturator hernia is rare. Clinical presentation is often non-specific and mortality is high, mostly due to late recognition. Early diagnosis and treatment are needed to reduce mortality.
Objective: To present a rare surgical entity with high mortality, and highlight the need for early diagnosis and treatment, even under limited resources.
Methodology: Retrospective study using records of patients who had been operated on for obturator hernia from November 1977 to May 2012 in the author’s rural practice. Patients’ biodata, mode of presentation, intervention and outcome, were studied.
Results: Eight patients were operated on for obturator hernia, but only seven, whose records could be retrieved, were recruited in this study. All were women, multiparous, and mostly elderly, with average age of 57.5 years. All had intestinal obstruction. At laparotomy, one (14.3%) had viable bowel, six (85.7%), bowel gangrene; five (85.7%) underwent full resection and anastomosis, and one (14.3%) had partial resection. Hernia defect was closed in four (57.1%). Wound infection was common (71.4%) and three (43%) died.
Conclusion: Obturator hernia is mainly a disease of elderly women and is rarely diagnosed preoperatively. The presentation is non-specific and the condition is seldom suspected. Preoperative diagnosis can be aided by advanced imaging modalities such as computed tomography and magnetic resonance imaging, but these are not readily available in areas of limited resources. Most patients present late with intestinal obstruction involving the small bowel, and mortality is high.

Keywords: Intestinal obstruction, Howship-Romberg sign, high mortality