special consideration: the obturator hernia
DESCRIPTION
TRANSCRIPT
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Special Consideration:The Obturator Hernia
George Ferzli MD, FACS
Staten Island University Hospital
Staten Island, New York
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Obturator Hernia• 1724 - described by Arnaud de Ronsil
• 1851 - First repair by Henry Obre
• Approximately 0.1% of all hernias
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Obturator Hernia• 9 : 1 female to male ratio
• Typical patient is > 70 yrs of age
• “Little old lady’s hernia”
• Up to 20% bilateral
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• Intestinal obstruction– most common presentation
• Up to 70% mortality with strangulation
CLINICAL PRESENTATION
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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
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ANATOMY• Formed by rami of the ischium and
pubis
• Bilaterally in anterolateral pelvic wall
• Inferior to the acetabulum
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Obturator Foramen
• Covered by obturator membrane
• Internal orifice closed by preperitoneal fat
• Contains obturator nerve and vessels
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Obturator Foramen
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MRI
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CT SCAN
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TAPP
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INCARCERATED - TEP
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STRANGULATED - TEP
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SUMMARY• Obturator hernia can be repaired
laparoscopically
• Bilateral inspection is mandatory
• Bowel viability must be assessed
• Mesh repair can be performed
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QUESTION Should prosthetic mesh be
used in the presence of intestinal perforation ?