Obturator Hernia

Published on 19/07/2015 by admin

Filed under Radiology

Last modified 19/07/2015

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 Hernia most commonly contains loop of Ileum, although can rarely involve other pelvic viscera (i.e., bladder)

image Most often trapped between obturator externus and pectineus muscles
image May also be located between superior and middle fasciculi of obturator externus or between internal and external obturator muscles
• Hernia sac exits pelvis near obturator vessels and nerve
• Right side more common

TOP DIFFERENTIAL DIAGNOSES

• Inguinal hernia
• Sciatic hernia
• Perineal hernia
• Femoral hernia

PATHOLOGY

• Defect in pelvic floor or laxity of pelvic muscles and fascia
• Made worse by any chronic increase in abdominal pressure (COPD, constipation, pregnancy, etc.)
• More common in thin or emaciated patients, as preperitoneal fat usually supports obturator canal

CLINICAL ISSUES

• Accounts for < 1% of all hernias
• > 90% occur in elderly women (mean age 82)

image Less common complication of pelvic floor laxity
• Acute or recurrent small bowel obstruction, partial > complete

image 80% of patients present with symptoms of bowel obstruction
image Majority require resection of strangulated small bowel
• Rare occurrence and nonspecific signs often lead to late diagnosis

image Correct clinical diagnosis in only 10–30% of cases
image Diagnosis best made by CT/MR rather than clinical exam
image
(Left) Graphic shows a bowel obstruction caused by an obturator hernia. Strangulated bowel image lies deep to the pectineus muscle image and superficial to the obturator externus muscle image.

image
(Right) Axial CECT in a 73-year-old woman shows a protrusion of portions of the bladder into bilateral obturator hernias image. Obturator hernias most commonly contain herniated ileum, but other pelvic viscera can also herniate, as in this case.
image
(Left) Axial CECT in a 90-year-old woman with bowel obstruction shows dilated proximal small bowel loops image and collapsed distal bowel image.

image
(Right) Axial CECT in the same patient shows the herniated and strangulated segment of the ileum image trapped between the obturator externus image and the pectineus image muscles. These are the classic imaging findings of an obturator hernia.

TERMINOLOGY

Abbreviations

• Obturator hernia (OH)

Definitions

• Pelvic hernia protruding through obturator foramen

IMAGING

General Features

• Best diagnostic clue

image CT evidence of herniated bowel lying between pectineus and obturator muscles in an elderly woman

Radiographic Findings

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