Surgery MCQ Answer 59

Answer: c

An obturator hernia is a hernia that occurs through the obturator canal, accompanied by the obturator vessels and the obturator nerve. Although rare, most obturator hernias occur in older multiparous women and are predominantly right-sided.

Symptoms are frequently intermittent but tend to be acute and become increasingly severe with incarceration of the hernia. Intestinal symptoms predominate, but dysesthesia or pain in the medial thigh with occasional radiation to the hip is often present. Dysesthesia results from compression of either division of the obturator nerve. Although the hernia is never externally visible, in a small percentage of patients a mass can be palpated in the upper, medial thigh. A correct diagnosis of obturator hernia is made in only about one-third of patients presenting with intestinal obstruction. Plain radiographs are seldom helpful, however a CT scan will usually confirm the diagnosis. Treatment is operative. There is no place for expectant therapy, especially in a patient with pain an parasthesias along the inner aspect of the thigh or with clinical or radiographic evidence of bowel obstruction.

Many surgical approaches have been promoted, but the transabdominal approach should be used because it has several advantages. It best confirms the diagnosis and exposes the obturator canal, orifice, vessels, and nerve, also permitting bowel resection when required. The sac is dealt with in a standard fashion. The hernia defect should be repaired, but repair usually requires a polypropylene mesh patch because the margin of the defect cannot be approximated primarily.

Category: Surgery MCQs