Via Research Recognition Day Program VCOM-Carolinas 2025

Case Reports

Obturator Hernia Presenting as Sciatic Nerve Pain: A Rare Case of Small Bowel Strangulation Brian Musch, DO 1 , Rachel Daley, OMS-III 2 , Saptarshi Biswas, MD, FACS 1 .

1. Grand Strand Medical Center, Dept. of Surgery, Myrtle Beach, SC. 2. Edward Via College of Osteopathic Medicine-Carolinas, Spartanburg, SC.

Background

Case Report Cont.

Discussion

Conclusions • Obturator hernias should be included in the differential diagnosis when frail elderly females present with signs of SBO • Howship-Romberg sign: medial thigh nerve pain relieved with hip flexion, exacerbated by hip adduction, abduction, and extension • Hannington-Kiff sign: absence of adductor reflex in the thigh • Prompt diagnosis and surgical intervention are critical to reducing morbidity and mortality • Risk factors include chronic illness, low body weight, history of previous abdominal surgery • Sciatic hernias can mimic obturator hernias, but this is the first documented case of an obturator hernia presenting with pain in the sciatic nerve distribution • Obturator hernias are rare, with variable clinical presentations • Occurs due to potential for bowel protrusion through the obturator canal, which passes through the obturator foramen and is covered by a thin membrane • Clinical signs

Case Report • Obturator hernias are rare, accounting for <0.04% of all hernias, with high mortality if unrecognized and untreated • Typically present with small bowel obstruction (SBO), but sciatic nerve pain distribution is a rare initial symptom due to obturator nerve compression • An 83-year-old thin female with a history of chronic colitis, hypertension, and hyperlipidemia • Recently hospitalized 10 days ago for intractable right-sided lumbar and sciatic pain • Presenting symptoms: Nausea, vomiting, and constipation for 2 days • Abdominal x-ray revealed SBO

Figure 2. CT scan of the abdomen showed diffuse fluid distension of the stomach and proximal small bowel compatible with distal small bowel obstruction • Exploratory laparotomy was performed and identified a strangulated knuckle of small bowel trapped within the obturator canal • Signs of small bowel ischemia and necrosis eventually led to small bowel resection and anastomosis

References

This research was supported (in whole or in part) by HCA Healthcare or an HCA Healthcare affiliated entity. Acknowledgements • Chung CC, Mok CO, Kwong KH, Ng EK, Lau WY, Li AK. Obturator hernia revisited: a review of 12 cases in 7 years. J R Coll Surg Edinb. 1997 Apr;42(2):82-4. • Mahendran B, Lopez PP. Obturator Hernia. [Updated 2023 Jan 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available at: https://www.ncbi.nlm.nih.gov/books/NBK554529/

Figure 1. Abdominal x-ray shows dilated loops of bowel

Figure 3. Strangulated loop of small bowel within the obturator hernia sac, leading to small bowel obstruction

2025 Research Recognition Day

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