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Obturator Hernia
An obturator hernia is a rare type of hernia of the pelvic floor in which pelvic or abdominal contents protrudes through the obturator foramen. Because of differences in anatomy, it is much more common in women, especially multiparous and older women who have recently lost much weight. The diagnosis is often made intraoperatively after presenting with bowel obstruction. The Howship–Romberg sign is suggestive of an obturator hernia, exacerbated by thigh extension, medial rotation and abduction. It is characterized by lancinating pain in the medial thigh/obturator distribution, extending to the knee; caused by hernia compression of the obturator nerve The obturator nerve in human anatomy arises from the ventral divisions of the second, third, and fourth lumbar nerves in the lumbar plexus; the branch from the third is the largest, while that from the second is often very small. Structure The ob .... References External links Hernias {{disease-stub ...
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General Surgery
General surgery is a surgical specialty that focuses on alimentary canal and abdominal contents including the esophagus, stomach, small intestine, large intestine, liver, pancreas, gallbladder, appendix and bile ducts, and often the thyroid gland. They also deal with diseases involving the skin, breast, soft tissue, trauma, peripheral artery disease and hernias and perform endoscopic procedures such as gastroscopy and colonoscopy. Scope General surgeons may sub-specialize into one or more of the following disciplines: Trauma surgery In many parts of the world including North America, Australia and the United Kingdom, the overall responsibility for trauma care falls under the auspices of general surgery. Some general surgeons obtain advanced training in this field (most commonly surgical critical care) and specialty certification surgical critical care. General surgeons must be able to deal initially with almost any surgical emergency. Often, they are the first port of c ...
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Hernia
A hernia is the abnormal exit of tissue or an organ (anatomy), organ, such as the bowel, through the wall of the cavity in which it normally resides. Various types of hernias can occur, most commonly involving the abdomen, and specifically the groin. Groin hernias are most commonly of the inguinal hernia, inguinal type but may also be femoral hernia, femoral. Other types of hernias include Hiatal hernia, hiatus, incisional hernia, incisional, and umbilical hernias. Symptoms are present in about 66% of people with groin hernias. This may include pain or discomfort in the lower abdomen, especially with coughing, exercise, or Urination, urinating or Defecation, defecating. Often, it gets worse throughout the day and improves when lying down. A bulge may appear at the site of hernia, that becomes larger when bending down. Groin hernias occur more often on the right than left side. The main concern is Strangulation (bowel), bowel strangulation, where the blood supply to part of the bowe ...
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Pelvic Floor
The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus muscle, and associated connective tissue which span the area underneath the pelvis. The pelvic diaphragm is a muscular partition formed by the levatores ani and coccygei, with which may be included the parietal pelvic fascia on their upper and lower aspects. The pelvic floor separates the pelvic cavity above from the perineal region (including perineum) below. Both males and females have a pelvic floor. To accommodate the birth canal, a female's pelvic cavity is larger than a male's. Structure The right and left levator ani lie almost horizontally in the floor of the pelvis, separated by a narrow gap that transmits the urethra, vagina, and anal canal. The levator ani is usually considered in three parts: pubococcygeus, puborectalis, and iliococcygeus. The pubococcygeus, the main part of the levator, runs backward from the body of the pubis toward the coccyx and may be damaged during ...
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Obturator Foramen
The obturator foramen (Latin foramen obturatum) is the large opening created by the ischium and pubis (bone), pubis bones of the pelvis through which nerves and blood vessels pass. Structure It is bounded by a thin, uneven margin, to which a strong membrane is attached, and presents, superiorly, a deep groove, the obturator groove, which runs from the pelvis obliquely medialward and downward. This groove is converted into the obturator canal by a ligamentous band, a specialized part of the obturator membrane, attached to two tubercles: * one, the posterior obturator tubercle, on the medial border of the ischium, just in front of the acetabular notch * the other, the anterior obturator tubercle, on the obturator crest of the superior pubic ramus, superior ramus of the pubis (bone), pubis Variation Reflecting the overall sex differences in human physiology, sex differences between male and female pelvises, the obturator foramina are oval in the male and wider and more triangular ...
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Gravidity And Parity
In biology and human medicine, gravidity and parity are the number of times a woman is or has been pregnant (gravidity) and carried the pregnancies to a viable gestational age (parity). These terms are usually coupled, sometimes with additional terms, to indicate more details of the woman's obstetric history. When using these terms: * Gravida indicates the number of times a woman is or has been pregnant, regardless of the pregnancy outcome. A current pregnancy, if any, is included in this count. A multiple pregnancy (e.g., twins, triplets, etc.) is counted as 1. * Parity, or "para", indicates the number of births (including live births and stillbirths) where pregnancies reached viable gestational age. A multiple pregnancy (e.g., twins, triplets, etc.) carried to viable gestational age is still counted as 1. * Abortus is the number of pregnancies that were lost prior to viable gestational age for any reason, including induced abortions or miscarriages but not stillbirths. The abort ...
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Bowel Obstruction
Bowel obstruction, also known as intestinal obstruction, is a mechanical or Ileus, functional obstruction of the Gastrointestinal tract#Lower gastrointestinal tract, intestines which prevents the normal movement of the products of digestion. Either the Small intestine, small bowel or Large intestine, large bowel may be affected. Signs and symptoms include abdominal pain, vomiting, abdominal bloating, bloating and not passing flatulence, gas. Mechanical obstruction is the cause of about 5 to 15% of cases of acute abdomen, severe abdominal pain of sudden onset requiring admission to hospital. Causes of bowel obstruction include Adhesion (medicine), adhesions, hernias, volvulus, endometriosis, inflammatory bowel disease, appendicitis, Neoplasm, tumors, diverticulitis, ischemic colitis, ischemic bowel, tuberculosis and intussusception (medical disorder), intussusception. Small bowel obstructions are most often due to adhesions and hernias while large bowel obstructions are most often ...
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Howship–Romberg Sign
The Howship–Romberg sign is inner thigh pain on internal rotation of the hip. It can be caused by an obturator hernia. It is named for John Howship and Moritz Heinrich Romberg.M. H. von Romberg. Pathologie und Therapie der Senisbilitäts- und Motilitätsneurosen. 1857. 3rd edition (unfinished) of Romberg’s Lehrbuch der Nervenkrankheiten des Menschen, page 89. References

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Obturator Nerve
The obturator nerve in human anatomy arises from the ventral divisions of the second, third, and fourth lumbar nerves in the lumbar plexus; the branch from the third is the largest, while that from the second is often very small. Structure The obturator nerve originates from the anterior divisions of the L2, L3, and L4 spinal nerve roots. It descends through the fibers of the psoas major, and emerges from its medial border near the brim of the pelvis. It then passes behind the common iliac arteries, and on the lateral side of the internal iliac artery and vein, and runs along the lateral wall of the lesser pelvis, above and in front of the obturator vessels, to the upper part of the obturator foramen. Here it enters the thigh, through the obturator canal, and divides into an anterior and a posterior branch, which are separated at first by some of the fibers of the obturator externus, and lower down by the adductor brevis. An accessory obturator nerve may be present in approx ...
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