Obturator hernia: embryology, anatomy, surgery

Abstract

Summary" Obturator hernia is relatively rare and typically affects frail, elderly, multiparous women. Most obturator hernias contain small intestine, usually a knuckle of ileum ; obstruction is often partial. A history of previous episodes of acute obstruction followed by remission is common. Strangulation eventually occurs, and surgical intervention is the only effective treatment. Pain in the medial aspect of the thigh, sometimes radiating to hip and knee joints (Howship-Romberg sign), and loss of the adductor reflex of the thigh in the presence of positive patellar reflex (Hannington-Kiff sign) are the only distinguishing symptoms. They are not always present or, if present, may be overlooked. For all practical purposes, the hernia through the obturator canal is never externally visible and a palpable mass is detected only occasionally. Thus, it is not suspected and was formerly rarely diagnosed before exploratory laparotomy. Intestinal obstruction of unknown origin was the usual preoperative diagnosis. More recently, however, with ultrasonography, CT scan, and laparoscopy, diagnosis has improved, paving the way for a decline in morbidity and mortality. We believe an abdominal approach is the treatment of choice (lower suprapubic transverse or lower midline incision).

Obturator canal fat plug: A pre‐hernial condition?

“…Some authors do not believe that the obturator canal fat plug is a pathological entity, as they have found it on all dissections and therefore consider it a cushion for the obturator nerve (Skandalakis et al, 2000). Despite careful dissection we found that only 22% of cadavers had fat plugs, and a larger series has found an even lower rate (Anson et al, 1950).…”

Symmetric Bilateral Aberrant Obturator Artery: A Case Report

“…When the lacunar ligament is opened, this branch vessel that passes behind it, above Cooper's ligament, could be damaged product of the staples or tacks placed on Cooper's ligament, leading to potentially fatal bleeding (Sabuncuoglu et al, 2015). The unexpected presence of the AOA can become a problem for the orthopaedic surgeon, urologist, gynecologist and general surgeon, any of which can perform surgical procedures in this area (Skandalakis et al, 2000). However, in clinical practice the incidence of excessive bleeding of these variant vessels is extremely low (Darmanis et al).…”

Laparoscopic transabdominal pre-peritoneal obturator hernia repair: An operative technique

“…The obturator foramen consists of the superior pubic ramus on the superior pubic body, inferior ramus on the medial, and ischial ramus on the inferior side [13]. The obturator foramen in the anteromedial pelvic wall is positioned in the inferior portion of acetabulum, typically located between the origin of the medial umbilical and lateral umbilical fold in the abdominal cavity.…”