OBTURATOR HERNIA REVISITED - A REVIEW OF 12 CASES IN 7 YEARS

Twelve patients with obturator hernia seen over a 7-year period were r eviewed retrospectively. All were elderly females presenting with smal l bowel obstruction. The median body weight was 35 kg. A significant p roportion of patients (33%) came from homes for elderly people and wer e either bed-ridden or wheel chair-bound. All 12 patients were classif ied as high-risk-patients in pre-operative assessment. Only one patien t (8.8%) had a history of previous abdominal operation. Clinical signs such as Howship-Romberg sign and palpable groin mass were absent in t hese patients. Contrast radiography was performed in three patients an d was not helpful in the diagnosis. A correct pre-operative diagnosis was suspected in only one case. The medium treatment delay was 1.5 day s and the gut resection rate mas 75%. The overall mortality rate was h igh (25%). A high index of clinical suspicion is important in the diag nosis and obturator hernia should be suspected whenever an elderly thi n female with no previous abdominal surgery developed small bowel obst ruction. Early laparotomy is recommended in such patients.