Hernias of the Pelvic Wall

  • Michael S. Kavic
  • Suzanne M. Kavic
  • Mary K. Hanissee
  • Stephen M. Kavic


There are several large openings in the bony pelvic girdle, including its floor that can allow for intestine or viscera to pass through and develop a hernia. However, the near vertical walls of the pelvis mitigate against the development of hernia—mitigate—but not completely deny hernia formation. Although rare, hernias of the deep pelvic structures can occur and cause debilitating symptoms. Unfortunately, physicians often ignore these symptoms because hernias in the pelvic areas are difficult to see and to palpate. For the most part, pelvic wall hernia is not even considered in females with vague abdominal or pelvic symptoms. Nonetheless, general surgeons need a thorough knowledge of pelvic anatomy, particularly, potential hernia sites in women, to avoid inadequate diagnostic workup and examination. Patients, usually older female patients, suffer the consequences of our inattention.


  1. 1.
    Howard FM. The role of laparoscopy in chronic pelvic pain: promise and pitfalls. Obstet Gynecol Surg. 1993;48(6):357–87.CrossRefGoogle Scholar
  2. 2.
    Kloch SC. Psychosomatic issues in obstetrics and gynecology. In: Ryan KJ, Berkowitz R, Barberi RL, editors. Kistner’s gynecology. Principles and practice. 6th ed. Mosby Yearbook Inc: St. Louis; 1995. p. 391–411.Google Scholar
  3. 3.
    Carter JE. Surgical treatment for chronic pelvic pain. JSLS. 1998;2(2):129–39.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Rapkin AJ, Mayer EA. Gastroenterologic causes of chronic pelvic pain. Obstet Gynecol Clin N Am. 1993;20(4):663–83.Google Scholar
  5. 5.
    Black S. Sciatic hernia. In: Nyhus LM, Condon RE, editors. Hernia. 2nd ed. Philadelphia: JB Lippincott; 1978. p. 443–52.Google Scholar
  6. 6.
    Watson LF. Hernia: anatomy, etiology, symptoms, diagnosis, differential diagnosis, prognosis and treatment. 3rd ed. CV Mosby: St Louis; 1948.Google Scholar
  7. 7.
    Miklos JR, O’Reilly MJ, Saye WB. Sciatic hernia: a cause of chronic pelvic pain in women. Obstet Gynecol. 1998;91(6):998–1001.PubMedGoogle Scholar
  8. 8.
    Cali RL, Pitsch RM, Blatchford GJ, et al. Rare pelvic floor hernias: report of a case and review of the literature. Dis Colon Rectum. 1991;25:604–12.Google Scholar
  9. 9.
    Porrett PM. The surgical review: an integrated basic and clinical science study guide. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2010. p. 85–123.Google Scholar
  10. 10.
    Gaffney LB, Schand J. Sciatic hernia: a case of congenital occurrence. Am J Surg. 1958;95:974.CrossRefGoogle Scholar
  11. 11.
    Losanoff J, Kjossen K. Sciatic hernia. Acta Chir Belg. 1995;95(6):269–70.PubMedGoogle Scholar
  12. 12.
    Kavic MS. Laparoscopic hernia repair. Amsterdam: Harwood Academic Publishers; 1997. p. 33–40.Google Scholar
  13. 13.
    Haraguchi M, Matsuo S, Kanetaka K, Tokai H, Azyma T, Yamaguchi S, Kanematsu T. Obturator hernia in an aging society. Ann Acad Med. 2007;36(6):413–5.Google Scholar
  14. 14.
    Nakayama T, Kobayashi S, Shiraishi K, Nishiumi T, Mori S, Isobe K, Furuta Y. Diagnosis and treatment of obturator hernia. Keio J Med. 2002;51(3):129–32.CrossRefGoogle Scholar
  15. 15.
    Gray SW, Skandalakis JE. Strangulated obturator hernia. In: Nyhus LM, Condon RE, editors. Hernia. 2nd ed. Philadelphia: JB Lippincott; 1978. p. 427–42.Google Scholar
  16. 16.
    Bjork KJ, Mucha P, Cahill DR. Obturator hernia. Surg Gynecol Obstet. 1988;167(3):217–22.PubMedGoogle Scholar
  17. 17.
    Ritz TA, Deshmukh N. Obturator hernia. South Med J. 1990;83:709–12.CrossRefGoogle Scholar
  18. 18.
    Fiser SM. The absite review. 4th ed. Philadelphia: Wolters Kluwer Health; 2014. p. 246–7.Google Scholar
  19. 19.
    Chan KV, Chan CK, Yau KW, Cheung MT. Surgical moritiy and mortality in obturator hernia: a 10-year retrospective risk factor evaluation. Hernia. 2014;18(3):387–92.CrossRefGoogle Scholar
  20. 20.
    Howship J. Practical remarks on the discrimination and appearances of surgical disease. London: John Churchill; 1840.Google Scholar
  21. 21.
    Romberg MH. Die operation des singeklemmten bruches des eirunden loches. Operatio hernia foraminis ovales incarceratae. In: Dieffenbach JF, editor. Die operative chirurgie, vol. 2. Leipzig: F.A. Brockhaus; 1848.Google Scholar
  22. 22.
    Chung CC, Mok CO, Kwong KH, Ng EK, Lau WY, Li AK. Obturator hernia revisited: a review of 12 cases in 7 years. J R Coll Surg Edinb. 1997;42:82–4.PubMedGoogle Scholar
  23. 23.
    Karasaki T, Nakagawa T, Tanaka N. Obturator hernia: the relationship between anatomical classification and the Howship-Romberg sign. Hernia. 2014;18(3):413–6.CrossRefGoogle Scholar
  24. 24.
    Singer R, Leary PM, Hofmeyer NG. Obturator hernia. S Afr Med J. 1955;29:74.Google Scholar
  25. 25.
    Xiaoyan C, Xiangyang S, Xiujun C. Stangulated intestinal obstruction secondary to a typical obturator hernia: a case report with literature review. Int J Med Sci. 2012;9(3):213–6.CrossRefGoogle Scholar
  26. 26.
    Hayama S, Ohtaka K, Takahashi Y, Ichimura T, Senmaru N, Hirano S. Laparoscopic reduction and repair for incarcerated obturator hernia: comparison with open surgery. Hernia. 2015;19(5):809–14. Scholar
  27. 27.
    Liu J, Zhu Y, Shen Y, Liu S, Wang M, Zhao X, Nie Y, Chen J. The feasibility of laparoscopic management of incarcerated obturator hernia. Surg Endosc. 2017;31(2):656–60.CrossRefGoogle Scholar
  28. 28.
    Ng DC, Tung KL, Tang CN, Li MK. Fifteen-year experience in managing obturator hernia: from open to laparoscopic approach. Hernia. 2014;18(3):381–6. Scholar
  29. 29.
    Stamatiou D, Skandalakis JE, Skandalakis LJ, Mirilas P. Perineal hernia: surgical anatomy, embryology, and technique of repair. Am Surg. 2010;76(5):474–9.PubMedGoogle Scholar
  30. 30.
    Penkov N, Damianov D, Asenov Y, Gerzilov P, Sedloev T. Recurrent perineal hernia–case report and review of the literature. Chirurgia. 2015;110(1):81–3.PubMedGoogle Scholar
  31. 31.
    Koontz AR. Perineal hernia. In: Nyhus LM, Condon RE, editors. Hernia. 2nd ed. Philadelphia: J.B. Lippincott; 1978. p. 453–62.Google Scholar
  32. 32.
    Gray SW, Skandalakis JE, McClusky DA. Atlas of surgical anatomy. Baltimore: Williams & Wilkens; 1985. p. 326–7.Google Scholar
  33. 33.
    Herrington JK. Occult inguinal hernia in the female. Ann Surg. 1995;181:481–3.CrossRefGoogle Scholar
  34. 34.
    Fodor PB, Webb WA. Indirect inguinal hernia in the female with no palpable sac. South Med J. 1974;64:15–6.CrossRefGoogle Scholar
  35. 35.
    Bascom JU. Pelvic pain. Perspect Colon Rectal Surg. 1999;11(2):21–40.Google Scholar
  36. 36.
    Fruchaud H. The Surgical Anatomy of Hernias of the Groin. (Translated and edited by Robert Bendavid, 2006). France: Gaston Doin & Cie; 1956. Printed in Canada by University of Toronto Press, First printing; 2006.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Michael S. Kavic
    • 1
    • 2
  • Suzanne M. Kavic
    • 3
  • Mary K. Hanissee
    • 4
  • Stephen M. Kavic
    • 5
  1. 1.Department of SurgerySt. Elizabeth Health CenterYoungstownUSA
  2. 2.Northeast Ohio Medical University, College of MedicineRootstownUSA
  3. 3.OB/GYN, Medicine Loyola University Medical Center 630-953-6669MaywoodUSA
  4. 4.Department of SurgeryUniversity of Maryland Medical CenterBaltimoreUSA
  5. 5.University of Maryland School of MedicineBaltimoreUSA

Personalised recommendations