Obturator hernia is a rare hernia that passes through the obturator foramen. Which classic clinical sign is pathognomonic of obturator hernia?
- A Carnett's sign — tenderness increasing on abdominal wall contraction
- B Howship-Romberg sign — inner thigh pain worsened by hip adduction, extension, or medial rotation due to compression of the obturator nerve ✓
- C Turner's sign — bruising of the flank indicating retroperitoneal haemorrhage
- D Hannington-Kiff sign — absent adductor reflex with present patellar reflex
Correct answer: B. Howship-Romberg sign — inner thigh pain worsened by hip adduction, extension, or medial rotation due to compression of the obturator nerve
Explanation
The Howship-Romberg sign is pathognomonic of obturator hernia: pain along the medial aspect of the thigh to the knee (obturator nerve distribution) that is worsened by hip adduction, extension, and internal rotation (manoeuvres that compress the nerve against the hernial contents in the obturator canal). It is relieved by hip flexion. Obturator hernia predominantly affects thin, elderly multiparous women and typically presents with small bowel obstruction. Diagnosis is usually confirmed by CT.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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