Lok Shin Yee, Sia Woon Teen, Morice Donald, Tanveer Amin
Department of General Surgery, Frankston Hospital, Peninsula Health, Victoria, Australia.
Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Malaysia.
Int J Surg Case Rep. 2025 Jan;126:110602. doi: 10.1016/j.ijscr.2024.110602. Epub 2024 Nov 13.
Obturator hernia is a rare type of pelvic hernia that often presents with vague symptoms that can easily be confused with other conditions. Delayed diagnosis can lead to increased morbidity and complications.
A 67-year-old female with a history of rheumatoid arthritis presented with escalating right knee pain, unresponsive to increasing doses of opioids. She also reported mild abdominal discomfort. A knee X-ray was unremarkable, but an abdominopelvic CT scan revealed an incarcerated obturator hernia. Emergent laparoscopic transabdominal pre-peritoneal (TAPP) repair was performed, leading to significant postoperative improvement in her knee pain.
This case highlights the unusual presentation of obturator hernia with referred knee pain, which could often be misdiagnosed as a musculoskeletal issue. The likely mechanism is obturator nerve impingement caused by the hernia, and surgical intervention successfully resolved the symptoms.
Clinicians should consider obturator hernia in the differential diagnosis of unexplained knee pain, particularly in patients with risk factors like advanced age, low body weight and the female gender, to avoid delayed diagnosis and prevent serious complications.
闭孔疝是一种罕见的盆腔疝，常表现为模糊的症状，容易与其他疾病混淆。延迟诊断会导致发病率和并发症增加。
一名67岁有类风湿关节炎病史的女性，出现右膝疼痛加剧，增加阿片类药物剂量后疼痛无缓解。她还报告有轻度腹部不适。膝关节X线检查无异常，但腹部盆腔CT扫描显示有绞窄性闭孔疝。急诊行腹腔镜经腹腹膜前（TAPP）修补术，术后膝关节疼痛明显改善。
该病例突出了闭孔疝伴牵涉性膝关节疼痛的不寻常表现，这种情况常被误诊为肌肉骨骼问题。可能的机制是疝导致闭孔神经受压，手术干预成功缓解了症状。
临床医生在鉴别诊断不明原因的膝关节疼痛时应考虑闭孔疝，尤其是在老年、低体重和女性等有危险因素的患者中，以避免延迟诊断并预防严重并发症。
