Overview
Obturator hernia is a rare but serious condition characterized by the protrusion of abdominal contents through the obturator canal, often leading to bowel obstruction and high complication rates, including mortality 13.Diagnosis
Clinical Presentation: Intermittent abdominal pain radiating to the medial thigh, nausea, and vomiting 4.
Imaging: CT scan with three-dimensional reconstruction is crucial for visualizing bowel loops protruding into the obturator canal 4.
Ultrasound: Can aid in diagnosis but CT is more definitive 2.Management
Emergency Exploratory Laparotomy (EEL): Indicated for incarcerated cases, especially when bowel necrosis is suspected or imminent 3.
Minimally Invasive Surgery: Feasible but evidence is limited; totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) approaches show potential 1.
Ultrasound-Guided Reduction (UGR): Can be safely performed for incarcerated hernias without bowel necrosis, followed by elective repair 2.
Timely Surgery: Delayed surgery can lead to complications such as bowel perforation and sepsis 4.Special Populations
Elderly: Higher risk of complications; emergency exploratory laparotomy remains a critical intervention 3.
Comorbidities: Presence of comorbidities may influence surgical approach and outcomes; individualized care is essential 34.Key Recommendations
Perform Emergency Exploratory Laparotomy for Incarcerated Obturator Hernia when bowel necrosis is suspected or to prevent complications 3 (Evidence: Strong).
Consider Ultrasound-Guided Reduction for Non-Necrotic Incarcerated Hernias followed by elective surgical repair to reduce postoperative morbidity 2 (Evidence: Moderate).
Avoid Delays in Surgical Intervention to prevent severe complications such as bowel perforation and sepsis 4 (Evidence: Weak).References
1 Baker S, Jaiswal S, Butnari V, Sardesai A, Mansuri A, Osilli D et al.. Emergency Minimally Invasive Surgery for Obturator Hernias: A Systematic Review. Annali italiani di chirurgia 2025. link
2 Kiyasu Y, Oka N, Mike M, Kusanagi H. Advantages of ultrasound-guided reduction and elective surgery versus emergency repair for incarcerated obturator hernia. Surgery today 2025. link
3 Wu TC, Lu Q, Liang XH. Efficacy of emergency exploratory laparotomy in incarcerated obturator hernia. Acta chirurgica Belgica 2018. link
4 Zhang H, Cong JC, Chen CS. Ileum perforation due to delayed operation in obturator hernia: a case report and review of literatures. World journal of gastroenterology 2010. link