Obturator Hernia

Posted by e-Medical PPT Tuesday, August 6, 2013
Protrusion of sac through obturator foramen and canal along the obturator nerve and vessels
Represents <0.1% of all hernias
High incidence of strangulation
“the skinny old lady hernia” - thin, frail, multiparous elderly woman with SBO of unclear etiology
Female-to-male ratio is 6:1
Female preponderance is due to the larger and more oblique incline of the obturator canal in the female pelvis
Occurs more frequently on the right side (sigmoid colon overlying obturator foramen on the left side)
Bilateral hernias in 6% of cases

Predisposing Factors
Increased intra-abdominal pressure
Constipation
COPD
Multiparity
Ascites
Rapid weight loss with a decrease in fatty tissue surrounding the obturator foramen

Anatomy of Obturator Foramen
Located within the anterolateral aspect of the pelvis
Formed by the ischial and pubic rami
Obturator membrane covers the majority of the foramen space, except for a small portion for obturator vessels and nerve to pass
Obturator vessels and nerve traverse the canal and enter the medial aspect of the thigh

Obturator Canal
2-3 cm long tunnel
begins in the pelvis
exits through the obturator foramen
passes obliquely downward to the obturator region of the thigh
The canal is bounded
superiorly and laterally by the pubic bone
inferiorly by the obturator membrane and obturator muscles

Obturator Canal Contents
Obturator nerve, artery, and vein enter the canal through an opening in the anterosuperior aspect of the obturator membrane
Obturator nerve lies superior to the obturator artery and divides immediately on exiting the canal into anterior and posterior branches

Obturator Nerve
Anterior branch emerges between the adductor longus and adductor brevis muscles
supplies sensory innervation to the medial aspect of the thigh, hip and knee joints and motor innervation to the adductor longus/brevis, gracilis, and pectineus muscles
Posterior division emerges between the adductor brevis and adductor magnus muscles
supplies motor innervation to the obturator externus and adductor magnus muscles...
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