A 78-year-old emaciated woman presents with colicky abdominal pain and vomiting. She reports pain radiating from the groin down the inner aspect of the thigh, relieved partly by flexion of the hip. Abdominal radiographs show small bowel obstruction. No groin swelling is palpable. The most likely diagnosis is:

• A Femoral hernia
• B Spigelian hernia
• C Obturator hernia ✓
• D Inguinal hernia

Explanation

An obturator hernia passes through the obturator canal and classically occurs in elderly, thin women. It presents with intestinal obstruction and Howship-Romberg sign, pain along the medial thigh caused by compression of the obturator nerve, often eased by hip flexion. The hernia lies deep to pectineus, so no groin lump is felt, which distinguishes it from a femoral hernia where a swelling below and lateral to the pubic tubercle is expected.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.