A 78-year-old frail woman presents with colicky abdominal pain, vomiting, and distension. She reports aching pain radiating down the medial aspect of her right thigh to the knee. There is fullness in the upper medial thigh with tenderness on internal rotation of the hip. The most likely diagnosis is:

• A Psoas abscess
• B Femoral hernia
• C Obturator hernia ✓
• D Saphena varix

Explanation

An obturator hernia passes through the obturator canal and classically occurs in thin, elderly women. Pain radiating down the medial thigh due to compression of the obturator nerve is the Howship-Romberg sign. It is a rare cause of bowel obstruction and is frequently missed until laparotomy. C femoral hernia produces a groin lump below the inguinal ligament without referred thigh pain, and a saphena varix is soft and reducible with a fluid thrill.

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.