Case Segmental resection of small bowel

Obturator Hernia Protrusion of sac through obturator foramen and canal along the obturator nerve and vessels Obturator canal Pelvis의 anterolateral aspect에 위치하며 ischium과 pubic ramus에 의해 형성됨 Obturator nerve와 vessel이 지나는 작은 부분을 제외하고는 obturator membrane으로 덮여 있음

Obturator Hernia Epidemiology Clinical manifestations Contents Very rare; 0.073% of all abdominal hernias 70-90 yrs of age; F:M=6~9:1 (d/t larger & more oblique incline of the canal) In thin patients or patients with massive weight loss Rt. > Lt. d/t sigmoid colon overlying the foramen on the left side Bilateral in 6-15% Clinical manifestations Abd. pain, N/V; thigh or knee pain Contents Ileum (m/c) Colon, appendix, omentum, bladder, uterus, adnexal tissues, etc. Small orifice → incarceration, strangulation ↑ Obturator canal 덮는 fat이 줄어들어서..

Obturator Hernia Imaging findings Plain abdomen: gas shadow in obturator foramen area CT - Low density mass between obturator externus and pectineus muscle - Bowel loop dilatation; small bowel obstruction Potential hernial pathway: 3 variants Btw obturator externus & pectineus mm., acompanied by ant. division of obturator n. Btw sup. & middle fasciculi of obturator externus along with post.division of n. Btw ext. & int. obturator mm. and membranes Obturator canal 덮는 fat이 줄어들어서.. Herniated bowel between right pectineus muscle and obturator externus muscle Herniated bowel between superior and middle fasciculi of right obturator externus muscle Mild bowel wall thickening with blurring of adjacent fat plane

F/84, Abdominal pain