# Rare Hernias

> Rare hernias for NEET-PG Surgery: obturator with Howship-Romberg sign, Spigelian, lumbar Grynfeltt and Petit, sciatic, Richter, Littre, Maydl and sliding hernias.

- Canonical URL: https://prepelephant.com/topics/neet-pg/surgery/rare-hernias
- Exam / course: NEET-PG · Subject: Surgery
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "Rare Hernias", PrepElephant, https://prepelephant.com/topics/neet-pg/surgery/rare-hernias

## Direct answer

The less common hernias asked in NEET-PG are defined by their eponyms and signature signs: obturator hernia through the obturator canal in an elderly emaciated woman, diagnosed by Howship-Romberg pain along the medial thigh relieved by hip flexion; Spigelian hernia through the Spigelian fascia at the semilunar line, usually below the arcuate line and often interparietal; lumbar hernia through the superior (Grynfeltt) or inferior (Petit) lumbar triangles; and sciatic, perineal and internal hernias completing the list. Special content hernias include the Richter (part of the bowel wall, strangulation without obstruction), Littre (Meckel diverticulum) and Maydl (W-shaped double loop); sliding hernias have a viscus forming the sac wall and must not be dissected off.

## What you must remember

- Obturator hernia: elderly women with weight loss; Howship-Romberg sign — medial thigh pain radiating to the knee, eased by hip flexion; obstruction with high strangulation risk; CT diagnosis, mesh repair at laparotomy.
- Spigelian hernia: through the aponeurotic layer lateral to the rectus along the semilunar line, mostly at the level of the arcuate line of Douglas; frequently interparietal, so the lump is ill-defined; ultrasound or CT confirms, and repair is by mesh.
- Lumbar hernias: superior triangle of Grynfeltt (bounded by the 12th rib, erector spinae and internal oblique) is the commoner; inferior triangle of Petit (latissimus dorsi, external oblique, iliac crest) is rarer.
- Richter hernia: only part of the bowel circumference is trapped — gangrene without intestinal obstruction; classic in femoral and obturator hernias.
- Littre hernia contains a Meckel diverticulum; Maydl hernia contains two adjacent loops so that the gangrenous loop may be missed when the distal viable loop is reduced first.
- Sliding hernia: a viscus (caecum, sigmoid or bladder) forms the posterior wall of the sac, which is inverted rather than detached, and the defect repaired with mesh.
- Internal hernias (paraduodenal fossae, the left fossa of Landzert being commonest; foramen of Winslow; postoperative mesenteric defects) present as closed-loop obstruction diagnosed on CT.

## Common confusion

Students mix up Howship-Romberg with psoas abscess or hip arthritis referral. Obturator neuralgia worsens with extension and internal rotation of the hip (nerve stretched) and is relieved by flexion, while the examiner should remember the patient is typically a thin elderly woman with obstruction signs. The second confusion is interparietal versus interstitial: interparietal (Spigelian) hernias spread within the layers of the abdominal wall, making the surface lump deceptively small.

## Exam-focused takeaway

Eponym-matching is the question format: Howship-Romberg to obturator, Grynfeltt and Petit to lumbar, Littre to Meckel, Maydl to double-loop strangulation, Richter to strangulation without obstruction. Stems feature an emaciated elderly woman with medial thigh pain and obstruction, or an ill-defined lump lateral to the rectus; all these hernias are repaired with mesh and CT is the diagnostic standard.

## Frequently asked questions

### What is the Howship-Romberg sign?
Pain along the distribution of the obturator nerve — the medial thigh radiating to the knee — aggravated by hip extension and internal rotation and relieved by flexion, from compression by an obturator hernia.

### Why are Spigelian hernias easy to miss?
They are frequently interparietal, dissecting between the layers of the abdominal wall, so the external bulge is subtle and diagnosis requires ultrasound or CT of the wall.

### What is a Maydl hernia and its danger?
A hernia containing two loops of bowel in a W shape, so that after reduction of the viable loop a gangrenous loop may remain unrecognised and be returned to the abdomen.

### How is a sliding hernia handled?
A viscus such as caecum, sigmoid or bladder forms part of the sac wall; the sac is inverted or excised away from the viscus and the defect repaired with mesh — never dissecting the viscus off.