A 83-year-old woman was admitted to our hospital because of intermittent abdominal colicky pain and vomiting for 26 h.The pain localized over the periumbilical area with radiation along the medial side of the thigh.Co...A 83-year-old woman was admitted to our hospital because of intermittent abdominal colicky pain and vomiting for 26 h.The pain localized over the periumbilical area with radiation along the medial side of the thigh.Computed tomography scan with three-dimensional reconstruction revealed a loop of small bowel protruding into the left obturator canal. Incarcerated obturator hernia was diagnosed and emergency laparotomy was arranged immediately. Unfortunately,her family refused surgery because of her worsening condition.On the third evening after admission,the patient developed peritonitis and sepsis. Perforation of small bowel due to the incarceration was noted during laparotomy.Bowel resection and an endileostomy were performed.She recovered well despite of the complication of multiple organ dysfunction syndrome.Literature is reviewed,and the pathogenesis,clinical manifestation,imaging features and treatment are discussed.展开更多
BACKGROUND Lateral thigh pain is a common complaint in patients visiting a pain clinic.Herein,we describe the case of a patient with lateral thigh pain caused by an obturator hernia.CASE SUMMARY An 83-year-old woman v...BACKGROUND Lateral thigh pain is a common complaint in patients visiting a pain clinic.Herein,we describe the case of a patient with lateral thigh pain caused by an obturator hernia.CASE SUMMARY An 83-year-old woman visited the emergency room with suddenly aggravated right lateral thigh pain.Magnetic resonance imaging of the thigh revealed no abnormal findings in the lateral thigh area.However,an obturator hernia between the pectineus and obturator externus muscles was observed by chance.Retroperitoneal computed tomography revealed a herniated small bowel with an incarceration point at the right obturator canal and a dilated loop of the small bowel upstream.Ultrasonography of the right inguinal region revealed a distended bowel loop in the right pectineus muscle.CONCLUSION Our report provides clinicians with information that an obturator hernia can cause lateral thigh pain.展开更多
Obturator hernia is a relatively rare pelvic hernia and usually occurs in elderly, thin, multiparous women.Because symptoms are nonspecific in most cases, diagnosis is often delayed until laparotomy is performed for t...Obturator hernia is a relatively rare pelvic hernia and usually occurs in elderly, thin, multiparous women.Because symptoms are nonspecific in most cases, diagnosis is often delayed until laparotomy is performed for treatment of bowel obstruction or peritonitis. Delay in diagnosis and surgical intervention directly contribute to high morbidity and mortality rates,Here we report a case of obturator hernia where the diagnosis was made by emergency preoperative abdominal CT scan.展开更多
Groin hernias include indirect inguinal, direct inguinal, and femoral hernias. Obturator and supravesical hernias appear very close to the groin. High-quality repairs are required for groin hernias. The concept of &qu...Groin hernias include indirect inguinal, direct inguinal, and femoral hernias. Obturator and supravesical hernias appear very close to the groin. High-quality repairs are required for groin hernias. The concept of "tension-free repair" is generally accepted, and surgical repairs with mesh are categorized as "hernioplasties". Surgeons should have good knowledge of the relevant anatomy. Physicians generally focus on the preperitoneal space, myopectineal orifice, topographic nerves, and regional vessels. Currently, laparoscopic surgery has therapeutic potential in the surgical setting for hernioplasty, with laparoscopic transabdominal preperitoneal(TAPP) repair appearing to be a powerful tool for use in adult hernia patients. TAPP offers the advantages of accurate diagnoses, repair of bilateral and recurrent hernias, less postoperative pain, early recovery allowing work and activities, tension-free repair of the preperitoneal(posterior) space, ability to cover obturator hernias, and avoidance of potential injury to the spermatic cord. The disadvantages of TAPP are the need for general anesthesia, adhering to a learning curve, higher cost, unexpected complications related to abdominal organs, adhesion to the mesh, unexpected injuries to vessels, prolonged operative time, and as-yet-unknown long-term outcomes. Both technical skill and anatomical familiarity are important for safe, reliable surgery. With increasing awareness of the importance of anatomy during TAPP repair, we address the skills and pitfalls during laparoscopic TAPP repair in adult patients using illustrations and schemas. We also address debatable points on this subject.展开更多
Purpose： The obturator artery and its accessory （aberrant） arising from different origins and crossing the pubic rami are vascular variations. The internal iliac artery usually provides the obturator artery which m...Purpose： The obturator artery and its accessory （aberrant） arising from different origins and crossing the pubic rami are vascular variations. The internal iliac artery usually provides the obturator artery which may communicates with the external iliac artery through either the accessory obturator or inferior epigastric artery. A collateral circulation between the external and internal lilac system is known as corona mortis. The aim of current study is to provide sufficient data of vascular variability crossing the pubic rami for clinical field. Methods： Present study includes 208 hemipelvises dissected in the Institution of Anatomy, Medical University of Graz. During dissection, the obturator artery and its accessory crossing the superior rami of pubic bone were found to have different origins. Results： The obturator artery arising from the external lilac artery and from the femoral artery accounts for 9.8% and 1.1% respectively. Therefore, it passes over the superior pubic rami in 10.9%. Further, the accessory （aberrant） artery arises only from the femoral artery in 1.1%. In present study, the vascular variation crossing the superior pubic rami with or without collateral circulation between external and internal iliac system referred as corona mortis is addressed. This study includes new classification of obturator and accessory obturator arteries as well as the corona mortis. It includes a comparison of corona mortis incidence in Austria population and other populations. The corona mortis found to be in 12% of Austrian population. Conclusion： A great attention of clinicians, radiologists, surgeons, orthopedic surgeons, obstetricians and gynecologists has to be considered before pubic surgical procedures such as internal fixation of pubic fracture, an inguinal hernia repair. Further, traumatic pubic rami fracture may lead to massive hemor- rhage due to laceration of the obturator artery.展开更多
基金Supported by The Grant of Education Department of Liaoning Province,2009A719
文摘A 83-year-old woman was admitted to our hospital because of intermittent abdominal colicky pain and vomiting for 26 h.The pain localized over the periumbilical area with radiation along the medial side of the thigh.Computed tomography scan with three-dimensional reconstruction revealed a loop of small bowel protruding into the left obturator canal. Incarcerated obturator hernia was diagnosed and emergency laparotomy was arranged immediately. Unfortunately,her family refused surgery because of her worsening condition.On the third evening after admission,the patient developed peritonitis and sepsis. Perforation of small bowel due to the incarceration was noted during laparotomy.Bowel resection and an endileostomy were performed.She recovered well despite of the complication of multiple organ dysfunction syndrome.Literature is reviewed,and the pathogenesis,clinical manifestation,imaging features and treatment are discussed.
基金the National Research Foundation of Korea Grant funded by the Korean Government,No.NRF-2021R1A2C1013073.
文摘BACKGROUND Lateral thigh pain is a common complaint in patients visiting a pain clinic.Herein,we describe the case of a patient with lateral thigh pain caused by an obturator hernia.CASE SUMMARY An 83-year-old woman visited the emergency room with suddenly aggravated right lateral thigh pain.Magnetic resonance imaging of the thigh revealed no abnormal findings in the lateral thigh area.However,an obturator hernia between the pectineus and obturator externus muscles was observed by chance.Retroperitoneal computed tomography revealed a herniated small bowel with an incarceration point at the right obturator canal and a dilated loop of the small bowel upstream.Ultrasonography of the right inguinal region revealed a distended bowel loop in the right pectineus muscle.CONCLUSION Our report provides clinicians with information that an obturator hernia can cause lateral thigh pain.
文摘Obturator hernia is a relatively rare pelvic hernia and usually occurs in elderly, thin, multiparous women.Because symptoms are nonspecific in most cases, diagnosis is often delayed until laparotomy is performed for treatment of bowel obstruction or peritonitis. Delay in diagnosis and surgical intervention directly contribute to high morbidity and mortality rates,Here we report a case of obturator hernia where the diagnosis was made by emergency preoperative abdominal CT scan.
文摘Groin hernias include indirect inguinal, direct inguinal, and femoral hernias. Obturator and supravesical hernias appear very close to the groin. High-quality repairs are required for groin hernias. The concept of "tension-free repair" is generally accepted, and surgical repairs with mesh are categorized as "hernioplasties". Surgeons should have good knowledge of the relevant anatomy. Physicians generally focus on the preperitoneal space, myopectineal orifice, topographic nerves, and regional vessels. Currently, laparoscopic surgery has therapeutic potential in the surgical setting for hernioplasty, with laparoscopic transabdominal preperitoneal(TAPP) repair appearing to be a powerful tool for use in adult hernia patients. TAPP offers the advantages of accurate diagnoses, repair of bilateral and recurrent hernias, less postoperative pain, early recovery allowing work and activities, tension-free repair of the preperitoneal(posterior) space, ability to cover obturator hernias, and avoidance of potential injury to the spermatic cord. The disadvantages of TAPP are the need for general anesthesia, adhering to a learning curve, higher cost, unexpected complications related to abdominal organs, adhesion to the mesh, unexpected injuries to vessels, prolonged operative time, and as-yet-unknown long-term outcomes. Both technical skill and anatomical familiarity are important for safe, reliable surgery. With increasing awareness of the importance of anatomy during TAPP repair, we address the skills and pitfalls during laparoscopic TAPP repair in adult patients using illustrations and schemas. We also address debatable points on this subject.
文摘Purpose： The obturator artery and its accessory （aberrant） arising from different origins and crossing the pubic rami are vascular variations. The internal iliac artery usually provides the obturator artery which may communicates with the external iliac artery through either the accessory obturator or inferior epigastric artery. A collateral circulation between the external and internal lilac system is known as corona mortis. The aim of current study is to provide sufficient data of vascular variability crossing the pubic rami for clinical field. Methods： Present study includes 208 hemipelvises dissected in the Institution of Anatomy, Medical University of Graz. During dissection, the obturator artery and its accessory crossing the superior rami of pubic bone were found to have different origins. Results： The obturator artery arising from the external lilac artery and from the femoral artery accounts for 9.8% and 1.1% respectively. Therefore, it passes over the superior pubic rami in 10.9%. Further, the accessory （aberrant） artery arises only from the femoral artery in 1.1%. In present study, the vascular variation crossing the superior pubic rami with or without collateral circulation between external and internal iliac system referred as corona mortis is addressed. This study includes new classification of obturator and accessory obturator arteries as well as the corona mortis. It includes a comparison of corona mortis incidence in Austria population and other populations. The corona mortis found to be in 12% of Austrian population. Conclusion： A great attention of clinicians, radiologists, surgeons, orthopedic surgeons, obstetricians and gynecologists has to be considered before pubic surgical procedures such as internal fixation of pubic fracture, an inguinal hernia repair. Further, traumatic pubic rami fracture may lead to massive hemor- rhage due to laceration of the obturator artery.
