1. Case
Segmental resection of small bowel

2. 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

3. 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..

4. 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

5. F/84, Abdominal pain