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Pelvic Trauma
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
Arterial bleedSuperior gluteal artery is the most common source in APC-III injury and posterior ring disruption.Obturator artery.Internal pudendal artery.
Embryology, Anatomy, and Physiology of the Bladder
Published in Karl H. Pang, Nadir I. Osman, James W.F. Catto, Christopher R. Chapple, Basic Urological Sciences, 2021
Allan Johnston, Tarik Amer, Omar Aboumarzouk, Hashim Hashim
Obturator arteryPasses immediately from the lateral pelvic wall to the upper aspect of the obturator foramen.Leaves the true pelvis via the obturator foramen.Crossed on its most medial aspect by the ureter (and the vas deferens in the male).Provides a vesical branch to the bladder.
SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
The arterial supply from the ligamentum teres contributes more significantly in childhood. The obturator artery gives off a branch via the ligamentum teres, which provides a negligible blood supply to the femoral head in adults. Lateral and medial circumflex femoral arteries supply the femoral head via retinacula, which reflect back in longitudinal bands over the hip capsule. Vessels from the diaphysis of cancellous bone provide a significant arterial blood supply in adulthood. Fractures that are intracapsular have a high risk of resultant avascular necrosis of the femoral head, as it is separated from the trochanteric anastomosis; peritrochanteric fractures leave this anastomosis undisturbed, and thus avascular necrosis is less likely. Slipped femoral epiphysis in children may disrupt the ligamentum teres, which provides a significant arterial blood supply to the femoral head in this age group – this is seen in Perthes disease.
Comparison of 30-degree and 0-degree laparoscopes in the visualisation of the inferior epigastric vessel, rectus abdominis muscle and bladder dome in gynaecologic laparoscopy
Published in Journal of Obstetrics and Gynaecology, 2022
Satit Klangsin, Nantaka Ngaojaruwong, Hatern Tintara
In the lower abdominal wall, the inferior epigastric artery (IEA) mostly arises from the external iliac artery; however, variants may arise from the femoral artery or share a common trunk with the obturator artery (Wong and Merkur 2016). The IEA runs below the medial edge of the rectus abdominis muscle; the risk of damage to these vessels has led surgeons to opt for laparotomy to avoid any consequent massive haemorrhage (Lin and Grow 1999; Alkatout et al. 2015). The landmarks of the IEA and rectus abdominis muscle at the anterior superior iliac spine vary: 3.7–5.43 cm from midline and 5–6 cm from midline, respectively (Epstein et al. 2004; Rahn et al. 2010; Burnett et al. 2016; Joy et al. 2016, 2017). To prevent an IEA injury, various techniques have been proposed; the most common techniques are direct visualisation of the IEA, edge of the rectus abdominis muscle, and bladder dome via the primary port (Hurd et al. 2003).
Balloon occlusion technique for embolization of unselectable hemorrhaging pelvic arteries in the setting of traumatic pelvic fractures
Published in Baylor University Medical Center Proceedings, 2018
Sean Gipson, Mathew Weissenborn, Chip Bell, Chet Rees
Hemostasis of hemorrhaging pelvic arteries via transcatheter arterial embolization is an established technique within the setting of pelvic fractures.1,2 Ideally, the traumatically injured and hemorrhaging pelvic vasculature would be selected during transcatheter arterial embolization; however, instances of unfavorable anatomy for such selection frequently occur, resulting in difficulty for the interventionalist and morbidity for the patient due to nonselective branch embolization.3 A technique has been described in particle embolization therapy for liver cancers for which selective embolization was unobtainable by standard means alone.4–7 This technique involves temporary occlusion of distal vessels with a microcatheter balloon for protection of nontarget vessels and embolization of target vessels through a proximally positioned microcatheter. The vessels distal to the microcatheter and proximal to the occlusion balloon are embolized while the vessels beyond the balloon are spared. Following embolization, the balloon is deflated, restoring normal blood flow to the nontarget vessels. Here we describe use of this technique in a woman with an unselectable hemorrhaging obturator artery.