Obturator hernia should be considered in the differential diagnosis of hip and knee pain

Obturator hernia is a rare disease usually occurring in debilitated elderly women. Pain radiating down the medial thigh and knee (Howship-Romberg sign) is a specific sign of the disease. Presently described is a case of obturator hernia in a 73-year-old female patient who presented with severe left hip pain radiating down the medial thigh and knee, nausea, and loss of appetite. Initially, vertebral disc herniation was thought to be cause, but abdomino-pelvic computed tomography scan revealed left strangulated obturator hernia. Diagnosis of obturator hernia can be challenging. Physicians should consider obturator hernia in the differential diagnosis of knee and hip pain, and investigate for Howship-Romberg sign. Early diagnosis of the disease not only decreases morbidity and mortality, but also presents opportunity to treat with minimally invasive methods.

Obturator herni kalça ve diz aðrýsýnýn ayýrýcý tanýsýnda yer almalýdýr

Obturator herni tüm hernilerin yaklaþýk olarak %0.05–1.4’ünü oluþturan nadir bir hastalýktýr. Genellikle zayýf, yaþlý ve düþkün kadýnlarda görülmektedir. Uyluk iç kýsmýndan dize yayýlan aðrý (Howship Romberg bulgusu) hastalýða özgüdür. Bu yazýda, obturator fýtýk tanýsý alan bir hasta ve obturator fýtýðýn tanýsal güçlükleri sunuldu. Yetmiþ üç yaþýnda düþkün bir hasta, bulantý, iþtahsýzlýk ve sol kalçasýndan uyluk iç kýsmýna ve dize yayýlan þiddetli aðrý þikayeti ile acil servise baþvurdu. Öncelikli vertebral disk hernisi düþünülen hastanýn çekilen abdomino-pelvik bilgisayarlý tomografisinde sol obturator fýtýk saptandý. Obturator fýtýk tanýsý güç olan nadir bir hastalýktýr. Hekimler kalça ve diz aðrýsýnýn ayýrýcý tanýsýnda obturator fýtýðý dahil etmelidirler ve lüzüm halinde Howship Romberg bulgusunu sorgulamalýdýrlar. Erken taný konulmasý hem mortalite ve morbiditeyi azaltmaktadýr hem de daha az invaziv yöntemlerle tedavi olanaðý sunmaktadýr.