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Pelvis and perineum
Published in David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings, McMinn’s Concise Human Anatomy, 2017
David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings
Obturator internus - arises from the lateral wall of the inside of the pelvis and the obturator membrane (Figs. 7.3, 7.8), and turns at 90° through the lesser sciatic notch, between the ischial tuberosity and spine, to reach the medial aspect of the greater trochanter of the femur. The obturator nerve runs below the pelvic brim to pass into the thigh through the obturator canal on the upper edge of this muscle.
Focal Treatments, Including Botulinum Toxin
Published in Valerie L. Stevenson, Louise Jarrett, Spasticity Management, 2016
Rachel Farrell, Katrina Buchanan
The obturator nerve is formed from the ventral branches of the L2, L3 and L4 roots within the psoas muscle; it then enters the pelvis and passes through the obturator canal into the thigh. Different technical approaches have been described, but efficacy rates are reported to be greatly improved through a combined approach of X-ray fluoroscopy, electrical stimulation and, more recently, US.134 By blocking the obturator nerve at the level of the obturator canal, the motor branches to both the superficial and deep adductor muscles are targeted with greater clinical effect.
The Liver (LR)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
Obturator hernia, a rare type of abdominal hernia also known as “little old lady’s hernia,” entraps the obturator nerve with pain and/or tingling and/or paresthesias along the medial thigh, down to the knee. Alternately, the patient with obturator hernia may present with vague symptoms suggestive of bowel obstruction, as when a loop of small intestine becomes lodged within the obturator canal. Patients with this condition may report a dull, cramping abdominal pain accompanied by nausea, and vomiting.2
Efficacy of emergency exploratory laparotomy in incarcerated obturator hernia
Published in Acta Chirurgica Belgica, 2018
Tian-Chong Wu, Qiao Lu, Xiao-Hui Liang
In the emergency room, all patients underwent physical examination, preoperative preparation, anesthesia risk assessment, abdominal plain X-ray examination and plain CT scan of abdomen before operation. With a working diagnosis of acute intestinal obstruction caused by IOH the EEL was carried out. Laparotomy was performed with a median abdominal incision. The dilated small intestines occupied the entire abdomen and some of the intestinal hernias embedded in the obturator canal, which were consistent with the CT scan findings. A number of incarcerated bowel areas, which were suspected of ischemic or gangrenous perforation, were examined and identified carefully. Partial intestinal resection was performed in the case with necrosis of incarcerated bowel. For the obturator hernia defect, discontinuous suture of Prolene 2-0 was taken to close the obturator defect. The hernia sac was reversed and single suture of Prolene 2-0 was used to close the obturator defect. The abdomen was washed with normal saline. The abdominal wall was sealed in layers with absorbable sutures, and the skin was closed with unabsorbable sutures. Analgesics were administered by parenteral. Continuing or discontinuing antibiotics according to clinical presentation. Oral intake was started as soon as the patient is able to tolerate or when the bowel function is restored. The patients were discharged from hospital when they were given adequate oral and mobilization. Postoperative complications were recorded during and after hospitalization. The follow-up time was at one week, 15 days, 3 months, 6 months and 12 months. Patients’ follow-up record was maintained and renewed in computer data. Patients were asked to immediately report any complications related to surgery, regardless of the duration of follow-up.