Sudden knee pain in an underweight, older woman: obturator hernia

Obturator hernia is rare, and remains a diagnostic and therapeutic challenge.1 The usual presentation of obturator hernia is acute small-bowel obstruction with strangulation, frequently necessitating emergency bowel resection. Because of laxity of the pelvic floor associated with a wide obturator ca...

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Bibliographic Details
Published in:The Lancet (British edition) 2014-07, Vol.384 (9938), p.206-206
Main Authors: Tateno, Yuki, MD, Adachi, Kensuke, Dr
Format: Article
Language:English
Subjects:
Acute Pain - etiology
Aged, 80 and over
Arthralgia - etiology
Biological and medical sciences
Diseases of the osteoarticular system
Female
Gastroenterology. Liver. Pancreas. Abdomen
General aspects
Hernia, Obturator - complications
Hernia, Obturator - diagnostic imaging
Hernias
Humans
Internal Medicine
Knee Joint
Laparoscopy
Medical sciences
Medical treatment
Osteoarthritis
Other diseases. Semiology
Stomach. Duodenum. Small intestine. Colon. Rectum. Anus
Thinness
Tomography, X-Ray Computed
Women
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Summary:Obturator hernia is rare, and remains a diagnostic and therapeutic challenge.1 The usual presentation of obturator hernia is acute small-bowel obstruction with strangulation, frequently necessitating emergency bowel resection. Because of laxity of the pelvic floor associated with a wide obturator canal, old age, previous pregnancy, emaciation, and raised intra-abdominal pressure, obturator hernia occurs almost exclusively in multiparous, underweight, older women.2 Because the sigmoid colon acts as an anatomical barrier, obturator hernia presents less frequently on the left side. Many possible surgical approaches exist for repairing obturator herniae, although the choice depends on individual circumstances.5 Laparoscopic techniques provide a minimally invasive option, and laparoscopy can clarify the best course of action in bowel incarceration and ambiguous cases. Because frail older women are poor candidates for surgery, delays in diagnosis cause high rates of morbidity and mortality, so the timing of CT during the symptomatic period is of paramount importance.5 Awareness of this disease process with its characteristic presentation is crucial.
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(14)60883-7