An elderly emaciated woman presents with pain radiating from the groin down the inner aspect of the thigh, worse on extension and adduction of the hip, and repeated episodes of unexplained small bowel obstruction. There is no palpable groin lump. Which hernia and corresponding eponymous sign are most likely?

• A Spigelian hernia with Cullen's sign
• B Obturator hernia with Howship-Romberg sign ✓
• C Femoral hernia with Romberg's sign
• D Sciatic hernia with Lanz sign

Explanation

An obturator hernia passes through the obturator canal and compresses the obturator nerve, producing pain along its cutaneous distribution to the medial thigh, aggravated by hip extension, adduction or internal rotation: the Howship-Romberg sign. It occurs typically in thin elderly women, is often occult without a palpable lump, and commonly presents as recurrent intestinal obstruction. B femoral hernia produces a palpable groin swelling and does not irritate the obturator nerve.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.