Initial imaging. Deep pelvis hernias are exceedingly rare, and little current literature is available, with the majority addressing obturator hernias and primarily case reports for the other entities. Obturator hernias comprise <1% of hernias [46]. Presenting symptoms are vague and varied and may be completely absent. Signs and symptoms include small- bowel obstruction (63%), vague and/or intractable abdominal/groin pain (57%), palpable medial thigh lump (10%), and thigh pain referred to the knee (37%) [46-48]. Referred pain is secondary to compression of the obturator nerve within the obturator foramen. Elderly women are most commonly affected, and diagnosis is most commonly made at surgery, often for inguinal hernia repair [47,49]. In a case series by Light et al [49] of 30 patients, 5 patients were suspected to have obturator hernia on clinical examination alone, with only 3 confirmed surgically. Because of the lack of specific symptoms and signs in the primarily elderly population, diagnosis is often delayed with significant morbidity (30%) and mortality (10%), with small-bowel resection performed in 47% of patients in one study [46,47]. Nasir et al [47], in a retrospective review, demonstrated diagnosis preoperatively in only 30% of patients, 3% clinically, and 27% with CT. Perineal hernias may be congenital or acquired. They are classified as anterior or posterior based on relative position to the superficial transverse perineal muscle [52]. Acquired perineal hernias are rare surgical complications, most often associated with oncologic surgeries for colorectal and genitourinary neoplasm such as abdominoperineal resection and cystectomy. Postprocedural pelvic floor weakening is implicated [53]. CT Abdomen and Pelvis Preoperative CT is excellent in diagnosing obturator hernia, although the diagnosis is seldom suspected, most often incidentally identified at abdominal pelvic imaging for the diagnosis of small-bowel obstruction.
Hernia. Initial imaging. Deep pelvis hernias are exceedingly rare, and little current literature is available, with the majority addressing obturator hernias and primarily case reports for the other entities. Obturator hernias comprise <1% of hernias [46]. Presenting symptoms are vague and varied and may be completely absent. Signs and symptoms include small- bowel obstruction (63%), vague and/or intractable abdominal/groin pain (57%), palpable medial thigh lump (10%), and thigh pain referred to the knee (37%) [46-48]. Referred pain is secondary to compression of the obturator nerve within the obturator foramen. Elderly women are most commonly affected, and diagnosis is most commonly made at surgery, often for inguinal hernia repair [47,49]. In a case series by Light et al [49] of 30 patients, 5 patients were suspected to have obturator hernia on clinical examination alone, with only 3 confirmed surgically. Because of the lack of specific symptoms and signs in the primarily elderly population, diagnosis is often delayed with significant morbidity (30%) and mortality (10%), with small-bowel resection performed in 47% of patients in one study [46,47]. Nasir et al [47], in a retrospective review, demonstrated diagnosis preoperatively in only 30% of patients, 3% clinically, and 27% with CT. Perineal hernias may be congenital or acquired. They are classified as anterior or posterior based on relative position to the superficial transverse perineal muscle [52]. Acquired perineal hernias are rare surgical complications, most often associated with oncologic surgeries for colorectal and genitourinary neoplasm such as abdominoperineal resection and cystectomy. Postprocedural pelvic floor weakening is implicated [53]. CT Abdomen and Pelvis Preoperative CT is excellent in diagnosing obturator hernia, although the diagnosis is seldom suspected, most often incidentally identified at abdominal pelvic imaging for the diagnosis of small-bowel obstruction.