Obturator hernia: Current diagnosis and treatment

Background. Obturator hernia is a rare pelvic hernia for which both diagnosis and therapy are difficult. Because symptoms are nonspecific and specific physical findings are often obscure, diagnosis of obturator hernia is often delayed until laparotomy for bowel obstruction. Strangulation is frequent, and mortality remains high (25%). Primary closure of the hernia defect is difficult because adjacent tissues are not easily mobilized. Although a variety of techniques have been described, surgical repair has not been standardized. Methods. We report a case of bilateral obturator hernia with incarceration in association with bilateral femoral hernia in which these problems were satisfactorily addressed. Results, The hernias were diagnosed by computed tomography (CT) scan, and repaired with synthetic mesh placed in the preperitoneal space. This technique is well suited to unilateral and bilateral combinations of obturator, inguinal and femoral hernias. CT scan in the work-up of severe gastrointestinal symptoms with weight loss may lead to a diagnosis of occult hernia thereby allowing elective repair and, hopefully, a reduction in mortality risk. Conclusions. We recommend CT scan for suspected obturator hernia and perperitoneal mesh repair of noninfected cases.