Obturator neuropathy complicating elective laparoscopic tubal occlusion

Femoral and obturator neuropathies

The femoral and obturator nerves both arise from the L2, L3, and L4 spinal nerve roots and descend into the pelvis before emerging in the lower limbs. The femoral nerve's primary function is knee extension and hip flexion, along with some sensory innervation to the leg. The obturator nerve's primary function is thigh adduction and sensory innervation to a small area of the medial thigh. Each may be injured by a variety of potential causes, many of them iatrogenic. Here, we review the anatomy of the femoral and obturator nerves and the clinical features and potential etiologies of femoral and obturator neuropathies. Their necessary investigations, including electrodiagnostic studies and imaging, their prognosis, and potential treatments, are discussed in this chapter.

Topographical relationships between the obturator nerve, artery, and vein in the lateral pelvic wall

INTRODUCTION AND HYPOTHESIS

The aims of this study were to determine the topographical relationships between the obturator nerve (ON), artery (OA), and vein (OV) in the lateral pelvic wall.

METHODS

One hundred and fifty hemipelvises of 84 Korean cadavers were dissected.

RESULTS

The ON, OA, and OV ran in that order (from upper to lower) within the lateral pelvic wall in 46.7 % of specimens. In 32 % of cases, the three structures were separated at the posterior portion of the wall and then converged toward the obturator canal (OC). In 10 %, the OA and OV were in contact with each other and separate from the ON; in 2 %, the ON was contiguous with the OA and separate from the OV; in 2.7 %, all three structures were in contact with each another. Alternately, the order of ON, OA, and OV was altered in the lateral pelvic wall in 41.3 % of specimens. Finally, in 12 % specimens, either the OA or OV or both were absent from the lateral pelvic wall.

CONCLUSIONS

The possibility of the presence of either the OA or OV being between the ON and the external iliac vein, and the potential contact between the ON and either the OA or OV in the lateral pelvic wall, should be borne in mind during pelvic procedures.

[The conflict between obturator nerve and ovary: a cadaveric and radioanatomic study]

The aim of this study was to describe the anatomical relationships between the ovary and the obturator nerve in its intrapelvic portion. Seven embalmed cadavers were dissected; 20 MRIs were then analyzed. The main distance between the lateral pole of the ovary and the obturator nerve was 29 mm. The authors describe various etiologies responsible for obturator neuralgia. An underdiagnosed cause is gonadal hypertrophy.

SURGICAL MANAGEMENT OF OBTURATOR NERVE LESIONS

OBJECTIVE

Obturator neuropathy is a rare condition that may result from orthopedic, gynecological, or urological procedures or injuries. These pathologies are amenable to surgical intervention, and an accurate physical examination and electromyography are necessary before treatment.

METHODS

Six patients with obturator nerve lesions underwent surgical exploration and decompression or primary repair. Their charts were retrospectively reviewed, and the electromyographic, surgical, and follow-up data were recorded.

RESULTS

Postoperatively, all patients reported improved symptoms in the form of pain relief, numbness resolution, or improved adductor muscle strength.

CONCLUSION

Obturator nerve injury is a treatable condition with minimal surgical complications and morbidities.