An anomalous origin of obturator artery: A case report Download

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Indian Journal of Basic and Applied Medical Research; September 2014: Vol.-3, Issue- 4, P. 293-295
Case Report:
An anomalous origin of obturator artery: A case report
HosapatnaMamatha , Antony Sylvan D’ Souza , Vrinda Ankolekar ,HemalathaBangera
Department of Anatomy, Kasturba Medical College, Manipal University, Manipal, Karnataka
Corresponding author: Vrinda Ankolekar
Date of submission: 12 June 2014; Date of publication: 15 September 2014
Abstract:
The obturator artery normally arises from the anterior trunk of internal iliac artery. Variations in its origin and
course has drawn attention of surgeons, anatomists and radiologists. The literature contains many articles that report
variable origins. Interesting variations in the origin and course of the principal arteries have long attracted the
attention of anatomists and surgeons. A case of abnormal origin of obturator artery was observed in a 55-year-old
male cadaver, while doing routine dissection for first year MBBS students in Kasturba Medical College, Manipal.
The artery was arising from the inferior epigastric artery close to its origin from external iliac artery. The artery later
crossed the external iliac vein and accompanied the obturator nerve and vein to enter the obturator canal. General
surgeons dealing with laparoscopic herniorrhaphy should be aware of the aberrant obturator artery.
Keywords: Internal iliac artery, obturator artery, abnormal obturator artery, obturator foramen
Introduction
descends almost vertically to the obturator foramen.
Obturator artery is one of the medium sized parietal
It is usually near the external iliac vein, lateral to the
branches of the anterior division of internal iliac
femoral ring, and is then safe in herniotomy.
artery. It inclines antero-inferiorly on the lateral
Sometimes it curves along the edge of the lacunar
pelvic wall and leaves the pelvic cavity by passing
part of the inguinal ligament, partly encircling the
through the obturator foramen. It supplies the medial
neck of a hernia sac, and may be inadvertently cut
side of the thigh. It is the most variable vessel among
during enlargement of the femoral ring in reducing a
1
the branches of the internal iliac artery .The obturator
femoral hernia3.
artery is more variable and arises as a direct branch
The anomalous obturator vessels and inferior
from the anterior division of internal iliac artery in
epigastric artery may be in a dangerous situation in
41.4% of instances, from the inferior epigastric artery
pelvic surgeries that require dissection or suturing
in 19.5%, from the superior gluteal artery in 10%,
along the pelvic rim4.
from the inferior gluteal-internal pudendal trunk in
Case Report
10% and by a double origin in 6.4%. In only 23% of
A case of abnormal origin of obturator artery was
instances is a similar origin noted on both sides2. In
observed in a 55-year-old male cadaver, while doing
20-30% of subjects the obturator artery is replaced by
routine dissection for first year MBBS students in
an enlarged pubic branch of the inferior epigastric
Kasturba Medical College, Manipal. The artery was
artery, which is calledabnormal obturator artery. It
arising from the inferior epigastric artery close to its
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Indian Journal of Basic and Applied Medical Research; September 2014: Vol.-3, Issue- 4, P. 293-295
origin from external iliac artery as shown in Fig 1.
The embryological explanations for the anomalies in
The arterycrossed the external iliac vein and
the arterial patterns of the limbs are based on an
descended vertically downwards to the obturator
unusual selection of channels from a primary
foramen. It accompanied the obturator nerve and vein
capillary plexus, wherein the most appropriate
to enter the obturator canal as shown in Fig 2.
channels enlarge while others retract and disappear,
Discussion
thereby establishing the final arterial pattern7,8. The
The obturator artery gives off a small branch to the
OA arises comparatively late in development as a
periosteum on the back of the pubic bone, which
supply to a plexus, which in turn is joined by the
anastomoses with the pubic branch of the inferior
axial artery of the lower limb that accompanies the
epigastric artery. In over a third of cases this
sciatic nerve9.
anastomotic connection opens up and no obturator
In cases of ligation of the internal iliac arteries and
artery arises from the internal iliac artery. Such
their branches in women undergoing pelvic surgery,
replacement by the branch from the inferior
as well as in cases of obstruction of the internal iliac
epigastric artery is named the “abnormal obturator
artery due to any cause, the OA and its branches will
artery”. Obturator artery is variable in its origin. It
be spared, especially the branch to the head of femur,
may arise from the common iliac, anterior division of
when the obturator artery arises from the external
the internal iliac (41.4%), inferior epigastric (25%),
iliac
superior gluteal (10%), inferior gluteal-internal
laparoscopic herniorrhaphy should be aware of the
pudendal trunk (10%), inferior gluteal (4.7%),
aberrant obturator artery that crosses the superior
internal pudendal (3.8%) or external iliac (1.1%)5.
pubic ramus and is susceptible to injuries during
A study done by Pavan
dissection of the Bogros space and mesh stapling
et al, obturator artery
artery.General
surgeons
dealing
with
presents considerable variation in its origin. It took
onto Cooper’s ligament 10.
origin most frequently fromthe anterior division of
The superior border of the iliopubic ramus is an area
internal iliac artery in 36 specimens (72%). Out of
of considerable concern for a variety of surgical
which, directly from anterior divisionin 20 specimens
specialists, as it serves as an anchoring site for
(40%), with ilio-lumbar artery in 5 specimens (10%),
inguinal and femoral hernia repairs. Surgeons
with inferior gluteal artery in 3 specimens(6%), with
operating on the lower abdomen and pelvis often
inferior vesical artery in 2 specimens (4%), with
retract the abdominal muscles laterally placing
middle rectal artery in 1 specimen (2%), with
pressure on the lateral pelvic walls. Thus, a complete
internalpudendal artery in 4 specimens (8%) and with
understanding of anatomy of this area is critical4. The
uterine artery in 1 specimen (2%). The obturator
relevance of this paper is to draw attention of those
artery tooorigin from the posterior division of internal
engaged in interventional maneuver into human
iliac artery in 9 specimens (18%), from external iliac
pelvis, as a variant obturator vessel can be
artery in 1specimen (2%), from inferior epigastric
inadvertently
artery in 3 specimens (6%) and was found to be
complications.
cut
results
in
very
serious
6
absent in 1specimen (2%) .
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Indian Journal of Basic and Applied Medical Research; September 2014: Vol.-3, Issue- 4, P. 293-295
Figure 1 showing origin of obturator artery from
Figure 2 showing the abnormal obturator
the inferior epigastric artery.
artery entering the obturator canal.
[ IIA-Internal iliac artery, EIA-External iliac artery,
[ IIA-Internal iliac artery, EIA-External iliac
AOA- Abnormal obturator artery, IEA- Inferior
artery, AOA- Abnormal obturator artery, IEA-
epigastric artery ]
Inferior epigastric artery ]
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