Obturator hernia

Dr Dan J Bell and A.Prof Frank Gaillard et al.

Obturator hernias are a rare type of abdominal hernia, and can be clinically very difficult to diagnose.

Typically obturator hernias occur in elderly women 3,4 or patients with chronically raised intra-abdominal pressure (e.g. ascites, COPD, chronic cough) 4.  It has been suggested that the female predominance of these hernias is the result of pregnancy, which leads to relaxation of the pelvic peritoneum and a wider and more horizontal obturator canal 4.

In general obturator hernias are asymptomatic unless 2

The obturator foramen is occluded by the obturator membrane which is pierced anterosuperiorly by the obturator artery, vein and nerve. This neurovascular bundle then travels along a 2-3 cm oblique tunnel, the obturator canal. It is through this deficiency that an obturator hernia occurs. Presumably, due to the sigmoid colon on the left, these hernias are more common on the right 4

The layers that the hernial neck passes through include:

The hernia will then lie superficial to obturator externus and deep and inferior to pectineus muscle.

The hernia may contain:

The diagnosis is readily made on CT/MRI with either fluid or bowel able to be traced along the aforementioned course to lie in the medial upper thigh.

Signs of complication including:

Treatment involves surgery and repair of the hernial orifice. 

If the hernia contains bowel, or can be clearly traced through the obturator foramen, then there are very few alternative diagnoses.

If seen with ultrasound, it may be mistaken for a bursa or acetabular labral cyst.

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Article information

rID: 7111
Section: Pathology
Synonyms or Alternate Spellings:
  • Obturator herniae
  • Obturator herniation
  • Obturator hernias

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