PMC6108096_01
Transversal CT scan. The yellow arrow indicates bowel in the obturator foramen
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Fig1
A CT of the abdomen identified the cause of the small bowel obstruction to be a herniation of the ileum between the internal and external obturator muscles (obturator foramen) with signs of incarceration, Figs. 1 and 2.
Coronary CT scan. The yellow arrow indicates bowel in the obturator foramen
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Fig2
A CT of the abdomen identified the cause of the small bowel obstruction to be a herniation of the ileum between the internal and external obturator muscles (obturator foramen) with signs of incarceration, Figs. 1 and 2.
Intraoperative finding. A segment of the small bowel was trapped in the obturator canal
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Fig3
An emergency diagnostic laparoscopy was performed and the trapped ileum segment was bluntly reduced, Fig. 3.
Laparoscopic management of the obturator hernia using an endoloop
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Fig4
The hernia was laparoscopically managed via resection and closure of the redundant peritoneum over the obturator foramen using an endoloop (Fig. 4.).
Intraoperative real-time ICG fluorescence angiography following bowel reduction. The left upper image demonstrates the laparoscopic mode; the middle image indicates the angiographic mode while the lower image indicates the fluorescence mode (corresponding to the enlarged image). Note the longitudinal discolouration in the middle of the anti-mesenteric bowel surface with lack of perfusion
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Fig5
ICG fluorescence angiography was performed following injection of 3 ml of ICG and the bowel perfusion was observed using the PINPOINT   system (PINPOINT; Novadaq, Canada). ICG fluorescence suggested the presence of irreversible ischaemia with the need of bowel resection, Fig. 5.
Real-Time ICG fluorescence image following anastomosis showing a well perfused anastomosis
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Fig6
Figure 6 demonstrates a normal bowel perfusion after ICG following anastomosis.