Incarcerated obturator hernia

ABSTRACT

Incarcerated obturator hernia is rare, only approximately 550 cases appearing in the literature since the first case was reported in 1924. The three cases treated at the University Hospital of the West Indies are presented. They demonstrate many of the clinical features of the condition. Most cases occur in elderly women and they almost always present with symptoms amd signs of small bowel obstruction. Pressure on the obturator nerve by the hernial sac in the obturator nerve by the hernial canal results in a positive Howship-Romberg sign in about 50 percent of the patients. If the diagnosis is suspected pre-operatively, confirmation may be obtained by computerized tomography. This, however, seems unnecessary as prompt exploration is advisable due to the high incidence of gangrene of the bowel. At surgery, attempts at reduction frequently result in damage to the small bowel, and resection is often necessary due to injury or gangrene. Closure of the entrance to the canal with interrupted non-absorbable sutures is adequate, and prosthetic material is necessary only for very large defects. The high mortality rate reported is probably due to the age and poor general condition of affected patients (AU)