What is the characteristic sign of an obturator (obturator) hernia, specifically the Howship-Romberg sign?

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Last updated: May 11, 2025 • View editorial policy

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.

References

Research

Obturator hernias: a systematic review of the literature.

Hernia : the journal of hernias and abdominal wall surgery, 2021

Research

Obturator hernia: the Mayo Clinic experience.

Hernia : the journal of hernias and abdominal wall surgery, 2012

Research

Obturator hernia: A diagnostic challenge.

International journal of surgery case reports, 2013

Research

Obturator hernia should be considered in the differential diagnosis of hip and knee pain.

Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES, 2016

Research

Bowel obstruction in obturator hernia: A challenging diagnosis.

International journal of surgery case reports, 2018

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.