An 80-year-old emaciated woman presents with pain radiating down the medial aspect of her thigh, worsened by hip extension and relieved by flexion. A small groin lump is impalpable. Which hernia classically produces this presentation?

• A Spigelian hernia
• B Obturator hernia ✓
• C Lumbar hernia of Grynfeltt
• D Interparietal hernia

Explanation

An obturator hernia passes through the obturator canal and compresses the obturator nerve, producing Howship-Romberg sign: medial thigh pain exacerbated by extension and relieved by flexion. It occurs typically in elderly, thin females and is often impalpable because it is hidden by the pectineus. A Spigelian hernia occurs at the semilunar line and does not irritate this nerve.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.