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Abdominal wall, hernia and umbilicus
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Obturator hernia, which passes through the obturator canal, occurs six times more frequently in women than in men. Most patients are aged >60 years. The swelling is liable to be overlooked because it is covered by pectineus. It seldom causes a definite swelling in Scarpa’s triangle, but, if the limb is flexed, abducted and rotated outwards, the hernia sometimes becomes apparent. The leg is usually kept in a semiflexed position and movement increases the pain. In more than 50% of cases of strangulated obturator hernia, pain is referred along the obturator nerve by its geniculate branch to the knee. On vaginal or rectal examination the hernia can sometimes be felt as a tender swelling in the region of the obturator foramen.
The Liver (LR)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
Obturator hernia, a rare type of abdominal hernia also known as “little old lady’s hernia,” entraps the obturator nerve with pain and/or tingling and/or paresthesias along the medial thigh, down to the knee. Alternately, the patient with obturator hernia may present with vague symptoms suggestive of bowel obstruction, as when a loop of small intestine becomes lodged within the obturator canal. Patients with this condition may report a dull, cramping abdominal pain accompanied by nausea, and vomiting.2
Introduction
Published in Alistair Burns, Michael A Horan, John E Clague, Gillian McLean, Geriatric Medicine for Old-Age Psychiatrists, 2005
Alistair Burns, Michael A Horan, John E Clague, Gillian McLean
Most patients will have simple, straightforward things wrong with them and not rare conditions. Learn the common disorders and then you will know when something does not quite �t. You can then look it up or seek help. Trying to be too clever can get you into trouble. Most doctors will not see more than one case of infective endocarditis during an entire professional lifetime; they will see lots of respiratory infections, uri�e infections and skin infections. Rare presentations of common conditions are much more common than rare disorders, even common presentations of rare conditions. However hard we try, we will make more misdiagnoses of obturator hernia than correct ones, mainly because the prior probability of this diagnosis is low. You will only recognise what you know, so make sure you know the common things.
Efficacy of emergency exploratory laparotomy in incarcerated obturator hernia
Published in Acta Chirurgica Belgica, 2018
Tian-Chong Wu, Qiao Lu, Xiao-Hui Liang
Incarcerated obturator hernia (IOH) is a scarce type of acute surgical disease, accounting for only 0.073% of all hernias in the West and 1% in the Far East and usually occurs in old, thin, fertile women, as a result of a widened pelvic and enlargement of the obturator [1]. Additional factors are chronic disease, malnutrition and the related conditions of intra-abdominal hypertension. Patients usually present with symptoms of bowel obstruction and, occasionally, pains along the ipsilateral obturator nerve distribution (Howship-Romberg sign) which is defined as the lower limb ache caused by obturator nerve compression [2]. However, the associated symptoms and signs of IOH usually are nonspecific, such as nausea and vomiting, abdominal or groin pain and so on. Among them, Howship–Romberg sign, which is found in 37–60% IOH patients, is of considerable specificity [3]. In general, IOH occurs more frequently in aged women, who usually describe their symptoms difficultly because of dementia. In fact, it is difficult for elderly people with dementia to express these symptoms [4]. Therefore, the correct diagnosis is a huge challenge for IOH.
Contextual attributes promote or hinder self-regulated learning: A qualitative study contrasting rural physicians with undergraduate learners in Japan
Published in Medical Teacher, 2018
Yasushi Matsuyama, Motoyuki Nakaya, Hitoaki Okazaki, Jimmie Leppink, Cees van der Vleuten
Eager to obtain basic information about an obturator hernia as quickly as possible, I planned to read UptoDate's summary and recommendation sections. However, when I searched UptoDate, I only found the term “obturator hernia” with no subsections of focus, and I eventually gave up when all I could find was a large summary on intestinal obstruction. The situation was the same when I consulted Harrison, which lacked even the basic information I wanted to know. […] I checked a textbook I found on the desk of my colleague, but it was no help. […] For the time being, I searched for articles using Google, PubMed, and Medical Online. (R4: PGY 6)