Carmine Grassi

By Luigi Conti, Carmine Grassi, Filippo Banchini, Deborah Bonfili, Gaetano Maria Cattaneo, Edoardo Baldini and Patrizio Capelli

The obturator hernia is a rare pelvic hernia that often presents with symptoms of bowel obstruction. Obturator hernia corresponds to 0.5–1.4% of all abdominal hernias. Entrapment of an intestinal segment within the obturator orifice, most often the ileum, less frequently Meckel’s diverticulum or omentum, can cause intestinal obstruction. The non-specific presenting symptoms make the diagnosis of this condition often unclear. Females are 6–9 times more likely than men to be subject to the pathology, mostly occurring in a multiparous, emaciated, elderly woman so it is also called “the little old lady’s hernia.” Risk factors such as chronic constipation, chronic obstructive pulmonary disease, ascites, kyphoscoliosis, and multiparty, can predispose patients to herniation. A sign of inconstant presentation may be the presence of a palpable mass or pain radiating from the inner thigh and knee—known as Howship–Romberg sign—but it could be misleading when confused with symptoms of gonarthrosis or lumbar vertebral disc pathology. CT scan of the abdomen and pelvis has been found to be the gold standard for preoperative diagnosis because of its superior sensitivity and accuracy with respect to other radiological exams. The only possible treatment for this pathology is surgery, and management depends on early diagnosis.

Part of the book: Hernia Surgery