Obturator hernia revisited: a review of 12 cases in 7 years

Twelve patients with obturator hernia seen over a 7-year period were reviewed retrospectively. All were elderly females presenting with small bowel obstruction. The median body weight was 35 kg. A significant proportion of patients (33%) came from homes for elderly people and were either bed-ridden or wheel chair-bound. All 12 patients were classified as high-risk-patients in pre-operative assessment. Only one patient (8.8%) had a history of previous abdominal operation. Clinical signs such as Howship-Romberg sign and palpable groin mass were absent in these patients. Contrast radiography was performed in three patients and was not helpful in the diagnosis. A correct pre-operative diagnosis was suspected in only one case. The medium treatment delay was 1.5 days and the gut resection rate was 75%. The overall mortality rate was high (25%). A high index of clinical suspicion is important in the diagnosis and obturator hernia should be suspected whenever an elderly thin female with no previous abdominal surgery developed small bowel obstruction. Early laparotomy is recommended in such patients.