Obturator hernia: A comprehensive review of epidemiology, pathophysiology, diagnosis, and management

Obturator hernia is an exceptionally rare condition, accounting for less than 1% of all hernias, yet it poses a life-threatening risk, predominantly affecting thin, elderly multiparous women. Clinically, it typically presents with non-specific symptoms, with small bowel obstruction being the most prevalent manifestation. This hernia develops when intra-abdominal or pelvic viscera—most commonly the ileum—protrude through the obturator canal. This protrusion commonly compresses the obturator nerve, resulting in local and systemic pathophysiological changes secondary to obstruction. Given the hernia's deep pelvic location and the poor sensitivity of physical examination in detecting it, computed tomography (CT) remains the gold standard for definitive diagnosis. Surgical repair is mandatory to address this condition. Optimal treatment outcomes depend on two crucial factors: early diagnosis, achieved by performing immediate CT imaging when clinical suspicion arises, and definitive minimally invasive repair, ideally via a laparoscopic mesh-based approach. Compared to open surgical techniques, this minimally invasive method is associated with significantly lower morbidity, mortality, and recurrence rates. Future research should focus on developing AI-assisted imaging tools to enable earlier diagnosis, refining minimally invasive surgical approaches, innovating mesh materials, and implementing precision management protocols to provide personalized care for high-risk populations.