Special Considerations: Obturator, Femoral, and Scrotal Hernias Scott D. Steinberg, M.D. Staten Island University Hospital...
Obturator Hernia <ul><li>Described by Arnaud de Ronsil in 1724 </li></ul><ul><li>First repair by Henry Obre in 1851 </li><...
Obturator Foramen <ul><li>Formed by rami of the ischium and pubis  </li></ul><ul><li>Bilaterally in anterolateral pelvic w...
Obturator Foramen
Clinical Presentation <ul><li>Most common presentation is intestinal obstruction </li></ul><ul><li>Howship-Romberg sign is...
Radiographic Imaging MRI CT SCAN
OBTURATOR CANAL
Laparoscopic Repair
Laparoscopic Anatomy
Femoral Hernia <ul><li>5-10% of all groin hernias in adults </li></ul>
FEMORAL CANAL
SCROTAL HERNIA
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Special Considerations: Obturator, Femoral and Scrotal Hernias

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  • Female predominance likely a result of multiparity, wider pelvis, larger obturator rings. High mortality rate is a reflection of the typical patient- frail, emaciated, with multiple comorbidities
  • Special Considerations: Obturator, Femoral and Scrotal Hernias

    1. 1. Special Considerations: Obturator, Femoral, and Scrotal Hernias Scott D. Steinberg, M.D. Staten Island University Hospital Staten Island, New York
    2. 2. Obturator Hernia <ul><li>Described by Arnaud de Ronsil in 1724 </li></ul><ul><li>First repair by Henry Obre in 1851 </li></ul><ul><li>Represents approximately 1% of all hernias </li></ul><ul><li>9 : 1 female to male ratio </li></ul><ul><li>Up to 70% mortality with strangulation </li></ul>
    3. 3. Obturator Foramen <ul><li>Formed by rami of the ischium and pubis </li></ul><ul><li>Bilaterally in anterolateral pelvic wall, inferior to the acetabulum </li></ul><ul><li>Covered by obturator membrane </li></ul><ul><li>Internal orifice closed by preperitoneal fat </li></ul><ul><li>Contains obturator nerve and vessels </li></ul>
    4. 4. Obturator Foramen
    5. 5. Clinical Presentation <ul><li>Most common presentation is intestinal obstruction </li></ul><ul><li>Howship-Romberg sign is pathognomonic (pain in medial thigh with extension, adduction, or medial rotation) </li></ul><ul><li>Hernia is not palpable externally </li></ul>
    6. 6. Radiographic Imaging MRI CT SCAN
    7. 7. OBTURATOR CANAL
    8. 8. Laparoscopic Repair
    9. 9. Laparoscopic Anatomy
    10. 10. Femoral Hernia <ul><li>5-10% of all groin hernias in adults </li></ul>
    11. 11. FEMORAL CANAL
    12. 12. SCROTAL HERNIA
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