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
 CLINICAL PRESENTATION

• Intestinal obstruction
– most common presentation
• Up to 70% mortality with strangulation
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 ?