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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 293 www.ijbamr.com P ISSN: 2250-284X , E ISSN : 2250-2858 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%) . 294 www.ijbamr.com P ISSN: 2250-284X , E ISSN : 2250-2858 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 ] References 1. Williams P, Bannister L, Berry M, CollinsP, Dyson M, Dussek J, Ferguson M, Gray’Anatomy. The anatomical basis of medicineand surgery, 38th edition, ChurchillLivingstone, Edinburgh, 1995, 1560. 2. Thirupathi R, Vishnumukkala et.al, Ananomalous origin of obturator artery and itsclinical importance in humans. Int J Anat Res,2013;01:02-06. 3. Hollinshead HW, Blood vessels in the pelvis in Anatomy for Surgeons Hoeber-Harper II:1958, 681-686. 4. Maneesha S, Tripta S, Richhpal S, Kaur AA, Variations of Obturator Artery in Man. Anat Physiol,2012, 2:105. doi:10.4172/2161-0940.1000105. 5. Bergman RA, Thompson SA, Afifi AK & Saadeh FA. Compendium of Human Anatomic variation: catalog, Atlas and World Literature. Urban and Schwazenberg, Baltimore and Munich, 1988. 6. Pavan PH , Sameen T, Angadi AV, Hussain SS. Morphological Study Of Obturator ArteryInternational Journal of Anatomy and Research,Int J Anat Res, 2014, 2(2):354-57. 7. Arey LB. The development of peripheral blood vessels. In The peripheral Blood Vessels (Ed Orbison J L & Smith D E), 1-16, Baltimore: Williams and Wilkins, 1963. 8. Fitzerald, MJT. Human Embryology, New York, Harper International. 1978;38-56. 9. Sanduno JR, Roig M, Rodriguez A, Ferreira B, Domenech JM. Rare origin of the OBA, inferior epigatric and femoral arteries from a common trunk. J. Anat. 1993;183: 161-3. 10. Pai MM, Krishnamurthy A, Prabhu LV, Pai MV, Kumar SA, Hadimani GA. Variability in the origin of the obturator artery. Clinics. 2009;64(9):897-901. 295 www.ijbamr.com P ISSN: 2250-284X , E ISSN : 2250-2858 Indian Journal of Basic and Applied Medical Research; September 2014: Vol.-3, Issue- 4, P. 293-295 294 www.ijbamr.com P ISSN: 2250-284X , E ISSN : 2250-2858