An emaciated 78-year-old woman presents with colicky abdominal pain and vomiting. She reports pain radiating from the groin down the inner aspect of the same thigh, relieved partly by flexing the hip. No groin swelling is palpable. Which diagnosis best explains these findings?

• A Lumbar disc prolapse with radiculopathy
• B Femoral hernia causing intestinal obstruction
• C Psoas abscess with referred hip pain
• D Obturator hernia causing intestinal obstruction ✓

Explanation

The Howship-Romberg sign, pain along the medial thigh due to compression of the obturator nerve by a hernia in the obturator canal, classically accompanies an obturator hernia. These hernias occur almost exclusively in thin elderly women, are frequently strangulated, and often present as intestinal obstruction without any visible groin lump, making them easy to miss. D femoral hernia produces a palpable swelling below the inguinal ligament, and the other options do not explain obstruction together with medial thigh neuralgia.

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.