From the Research
The Howship-Romberg sign is characteristic of obturator hernia (option c). This clinical sign presents as pain along the medial aspect of the thigh that extends to the knee, which worsens with extension, adduction, or medial rotation of the hip. It occurs because an obturator hernia compresses the obturator nerve as it passes through the obturator canal. The obturator nerve provides sensory innervation to the medial thigh and motor function to the adductor muscles, explaining the distribution of pain.
Key Points
- Obturator hernias are rare but have high mortality rates due to delayed diagnosis, occurring most commonly in elderly, thin women 1.
- The Howship-Romberg sign is an important diagnostic clue that should prompt further investigation with imaging studies such as CT scans when suspected, as early diagnosis and surgical intervention are crucial for successful management of this condition 2, 3, 4, 5.
- A systematic review of the literature found that computed tomography (CT) scan was the most frequently used diagnostic modality, inversely associated with perioperative mortality, and that mesh repair demonstrated a significantly improved perioperative morbidity rate, compared with non-mesh repair 1.
- The laparoscopic approach has been associated with significantly decreased morbidity and mortality rate as well as length of hospital stay, compared with the open repair 1.
- The Howship-Romberg sign was present in 56.2% of patients with obturator hernias, according to a systematic review of the literature 1.
Diagnosis and Treatment
- CT scan of the abdomen is the gold standard diagnostic tool for obturator hernias 1.
- Operative repair is mandatory, with the laparoscopic approach demonstrating significant advantages over the open repair 1.
- Early diagnosis and surgical intervention are crucial for successful management of obturator hernias, as delayed diagnosis can lead to high mortality rates 2, 3, 4, 5.