Obturator hernia in adults: a systematic review of CT diagnosis and surgical management

Clinical Snapshot

Key Findings

• P Value: Not applicable - descriptive analysis

• Effect Size: Bowel resection required in 31.6% of cases

• Primary Outcome: CT diagnostic sensitivity of 93.2% for obturator hernia detection

• Nnt Or Sensitivity: CT sensitivity range 66.7-100%, specificity not reported

• Confidence Interval: Not provided due to data heterogeneity

Clinical Application

CT readily available in Australian hospitals; surgical expertise may be limited given rarity of condition Relevant to Australian practice given aging population; CT covered by Medicare; surgical management aligns with RACS guidelines for emergency surgery Elderly patients (especially women) presenting with bowel obstruction or groin pain in Australian emergency departments

Abstract

PURPOSE: Obturator hernia is a rare but life-threatening pelvic floor hernia occurring predominantly in elderly, underweight women and is associated with delayed diagnosis and high perioperative mortality. This systematic review evaluated the diagnostic performance of computed tomography (CT), factors associated with bowel resection, and short-term outcomes of open versus laparoscopic repair in adults. METHODS: A systematic review was conducted per PRISMA 2020. PubMed/MEDLINE, Scopus, and Web of Science were searched from January 2004 to January 2026. Studies reporting at least three surgically confirmed adult cases were eligible. Three consecutive institutional cases were incorporated as an illustrative clinical adjunct. RESULTS: Twenty-two studies including 876 patients were analysed. The mean age across included studies was 79.7 years; 91.5% were female. Reported preoperative CT sensitivity across included studies was 93.2% (range 66.7-100%). Bowel resection was required in 31.6% and was associated with higher 30-day mortality (19.6% vs. 3.9%). Laparoscopic repair appeared to be associated with lower wound morbidity, shorter hospital stay (5.3 vs. 12.6 days), and lower recurrence (0% vs. 2.8%) in selected patient cohorts, although case-mix differences preclude direct comparison. Mesh was used in 44.3% overall. In three institutional cases (all elderly cachectic women presenting emergently), one underwent TAPP and two underwent open midline laparotomy; primary suture repair was performed in all owing to contamination, bowel compromise, or extreme frailty. CONCLUSION: CT remains the diagnostic cornerstone in obturator hernia. Surgical strategy should be individualised based on haemodynamic status, contamination, and frailty. Reported outcomes represent descriptive trends rather than pooled statistical estimates due to heterogeneity of available data.

References

1. 1.Bademkıran, E. (2026). Obturator hernia in adults: a systematic review of CT diagnosis and surgical management. Hernia, advance online publication. https://doi.org/10.14744/tjtes.2023.07891