0:00

Let's bring in the next case.

0:02

Now, this is a little late.

0:03

Let's say she's 86.

0:04

Okay?

0:04

So she's a little bit older than our other one.

0:06

The other woman has been playing a lot of pickleball.

0:08

This woman has gone on to just being playing bridge.

0:10

So she's a little bit older, and you have

0:12

a very dilated loops of small bowel.

0:13

Again.

0:14

Now, this time you are obstructed as well, and

0:16

you're going to look for the cause of obstruction.

0:18

You're going to look for hernia because

0:19

I've already told you that gets you home

0:20

faster, and that is the easiest diagnosis.

0:23

And, you know, make your cases as fast as

0:25

possible, especially when you're on night shifts.

0:26

'Cause there's always another case to be read.

0:28

Um, you can see there's even some ascites now as we

0:30

come down to the groin location, coming through this.

0:35

For foramen, you're going to see a loop of small bowel.

0:37

These are extremely easy to miss.

0:40

You almost have to stop yourself on every person who

0:44

has a small bowel obstruction and just interrogate

0:46

this triangle on each patient to make sure you

0:48

aren't going to miss this hernia because these

0:50

are just like a little knuckle of small bowel, and

0:53

they have a really high rate of strangulation.

0:55

Um, it's very, very narrow orifice that this

0:57

is herniating through on landmarks again.

1:01

Pubic tubercle posterior to that horizontal line.

1:04

And here's the pectineus muscle.

1:06

Not the most loved muscle, but I like it.

1:08

And this hernia is posterior

1:10

to the pectineus muscle cell.

1:11

So watching it go through the obturator

1:13

canal there, posterior to the pectineus muscle,

1:16

this is indeed the obturator foramen hernia.

1:19

They're not common.

1:20

They're not common, but I have to

1:22

say, they're one of the more common.

1:24

Hernias that my trainees come back and tell me

1:26

that they made the diagnosis of this, and that they

1:29

appreciated having learned this hernia because

1:31

it's not common, but it's a hard diagnosis, and

1:34

we're into radiology to make the hard diagnoses.

1:37

That's why we do this profession, is to make the

1:39

diagnoses that really help patients, and this is

1:41

a hernia that causes strangulation and can be a

1:44

cause for really high morbidity and mortality in

1:48

this population, who is oftentimes very elderly.