THE SCOPE OF PELVIC HERNIAS - TAKING A LAPAROSCOPIC APPROACH TO OBTURATOR HERNIAS AND REPAIR OF INCIDENTAL SYNCHRONOUS HERNIAS

Objectives: Obturator hernias are a rare type of pelvic hernias that account for less than 1.5% of all hernias encountered. Unlike other inguinal or abdominal hernias, the obturator hernia through the obturator membrane rarely causes a palpable lump, making the diagnosis challenging. The classic exam finding for an obturator hernia is the Howship-Rhomberg sign in which pain in the medial thigh is elicited with medial rotation. Due to the rarity of these hernias, there is no consensus on the best way to diagnose and repair obturator hernias.

We present a 70-year-old female who complained of acute onset sharp, right groin pain with radiation down the leg. Her pain worsened with any movement or palpation of the groin. On CT scan, she was found to have an incarcerated right obturator hernia containing fat. The patient was taken to the operating room for laparoscopic exploration and repair of the obturator hernia in which concomitant bilateral femoral hernias were also discovered. Laparoscopic bilateral inguinal hernia repair with mesh was performed. The patient was discharged home two days later with successful repair.

Obturator hernias are uncommon with few cases reported of concomitant femoral hernias present. Open primary suture repair is the most common method of obturator hernia repair cited, however, laparoscopic mesh repair may be a better method of repair with lower recurrence rates. Due to the possibility of incidental synchronous inguinal hernias, the authors advocate for laparoscopic exploration with mesh repair to prevent missed hernias and increased rates of recurrence.

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