The entire section of the AOA, which can occur during pelvic surgery, could lead to a dangerous bleeding and difficult hemostasis, especially when the divided vessel retracts through the obturator foramen
(Lau & Lee).
The obturator foramen
is formed by continuity of pubic and ischial bones and is covered by obturator membrane except in its anterosuperior aspect where it is perforated by obturator nerve, artery, and vein.
It arises from: i) the margins of the obturator foramen
, ii) pubic and ischial rami, and iii) the external surface of the obturator membrane, the tendinous aponeurotic arch which completes the obturator canal.
If these maneuvers prove unsuccessful, as in our case, open reduction with the assistance of a bone hook should be performed, as the prosthetic femoral head may be physically lodged in the obturator foramen
A Prolene tape obtained by cutting a tape 10 mm large and 30 cm long from a mesh 30X30 cm is attached to the specific needle which is then taken out from the obturator foramen
. (Pic 5;) The same technique is used on the other side to pass the other extremity of the tape.
It then traveled forwards, infero-lateral to the common trunk of internal pudendal and inferior gluteal artery, it further coursed forwards and downwards lying over the ischio-coccygeal part of levator ani to reach the upper part of obturator foramen
, running parallel and inferior to the obturator nerve.
The pedicle was found on axial and coronal images to extend through the obturator canal and emerge from the obturator foramen
in the proximity of the inferior recess of the left hip joint capsule (Figs.
We report the case of a traumatic obturator foramen
hip dislocation in a 15-year-old boy.
Specially shaped trocars are used to access the retropubic space for sling placement, whereas differentially shaped trocars are used to access the obturator foramen
for sling placement.
For the anterior compartment repair, 2 implant straps on each side are placed via the obturator foramen
in the arcus tendinus fasciae pelvis.
The anterior branch of the obturator artery, which runs along the exterior edge of the obturator foramen
, is the structure of most concern.
The neurovascular bundle then exits the pelvis at the supero-lateral corner of the obturator foramen
. Injury to these structures has been reported, (4) and can occur with acetabular screw fixation in the antero-inferior quadrant or from retractors retractors placed underneath the transverse acetabular ligament.