An 80-year-old thin, bedridden woman presents with colicky abdominal pain and vomiting. She reports pain radiating down the medial side of her right thigh, relieved by flexion of the hip. Examination shows no groin lump. Which diagnosis explains these findings?

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

Explanation

Pain radiating down the medial thigh from compression of the obturator nerve by a herniating loop through the obturator canal is the Howship-Romberg sign, classical of obturator hernia. It occurs in elderly, emaciated, multiparous women and classically presents as intestinal obstruction without any palpable groin lump, since the hernia is hidden deep to the pectineus. A strangulated femoral hernia produces a palpable groin lump, and a psoas abscess causes hip flexion deformity rather than obstruction.

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.