Panajiotis N. Skandalakis

Surgical anatomy and technique

(2nd Edition) Preface. Acknowledgements. Skin, Scalp and Nail. Neck. Breast. Abdominal Wall and Hernias. Diaphragm. Esophagus. Stomach. Duodenum. Pancreas. Small Intestine. Appendix. Colon and Anorectum. Liver. Extrahepatic. Biliary Tract. Spleen. Adrenal Glands. Carpal Tunnel. Varicosities of the Lower Extremity. Laparoscopic Surgery.

Obturator hernia: embryology, anatomy, surgery

SummaryObturator hernia is relatively rare and typically affects frail, elderly, multiparous women. Most obturator hernias contain small intestine, usually a knuckle of ileum; obstruction is often partial. A history of previous episodes of acute obstruction followed by remission is common. Strangulation eventually occurs, and surgical intervention is the only effective treatment. Pain in the medial aspect of the thigh, sometimes radiating to hip and knee joints (Howship-Romberg sign), and loss of the adductor reflex of the thigh in the presence of positive patellar reflex (Hannington-Kiff sign) are the only distinguishing symptoms. They are not always present or, if present, may be overlooked. For all practical purposes, the hernia through the obturator canal is never externally visible and a palpable mass is detected only occasionally. Thus, it is not suspected and was formerly rarely diagnosed before exploratory laparotomy. Intestinal obstruction of unknown origin was the usual preoperative diagnosis. More recently, however, with ultrasonography, I CT scan, and laparoscopy, diagnosis has improved, paving the way for a decline in morbidity and mortality. We believe an abdominal approach is the treatment of choice (lower suprapubic transverse or lower midline incision).