Major Bleed Post Minimally Invasive Surgical Repair of Inguinal Hernia

Gupta, Anupam; Burgos, Monica I; Rodriguez, Antonio J Santiago; Lopez-Viego, Miguel A.; Ramseyer, Matthew M

doi:10.7759/cureus.9940

Cited by 4 publications

(3 citation statements)

References 11 publications

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“…Most of the time, the CM vessel arises from the inferior epigastric vessel so we must be careful while dissecting near this vessel, especially during reduction of the direct hernia sac or peritoneum. We must lower CO 2 insufflation pressure to less than 10 mm Hg to visualise a CM vein 10 11. Injuries can occur during the mesh fixing process at Cooper’s ligament if this vessel is not observed during dissection.…”

Section: Discussionmentioning

confidence: 99%

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Encountering the corona mortis vessel during laparoscopic totally extraperitoneal mesh hernioplasty and its significance

Saini,

Alla,

Verma

et al. 2024

BMJ Case Rep

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Corona mortis (CM) is an anastomotic vessel between the inferior epigastric or external iliac vessels and the obturator or internal iliac vessels. The Latin meaning of it is ‘crown of death’ which corresponds to massive haemorrhage caused by injury to this vessel during surgery. The incidence of this vessel is around 50% in the hemipelvis. We are presenting an intraoperative video of a right laparoscopic totally extraperitoneal mesh hernioplasty demonstrating a CM artery in the right hemipelvis. Care was taken to prevent injury to this vessel. CO2insufflation pressure was reduced to less than 10 mm Hg to see any venous variant of this vessel. Carefully, polypropylene mesh was placed without a fixation device. Anatomical knowledge of the CM vessel is therefore essential in preventing injury for surgeons who approach the inguinal and retropubic regions.

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Section: Discussionmentioning

confidence: 99%

“…We should be more vigilant for such variation on the superior pubic ramus and if a CM is visualised, extra care must be taken while applying a fixation device over the mesh with Cooper’s ligament. If there is an injury to this vessel, complete haemostasis must be achieved by ligating both bleeding ends 10 11…”

Section: Discussionmentioning

confidence: 99%

Encountering the corona mortis vessel during laparoscopic totally extraperitoneal mesh hernioplasty and its significance

Saini,

Alla,

Verma

et al. 2024

BMJ Case Rep

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“…Cremasteric artery injury is a rare complication of hernioplasty surgery, with only a few cases reported in the literature. The most common symptoms of cremasteric artery injury are persistent scrotal swelling and bleeding, which can occur immediately after surgery or several days later (4). In some cases, the bleeding may be concealed, making it difficult to diagnose (5).…”

Section: Discussionmentioning

confidence: 99%

Angioembolisation of Cremasteric Artery for Scrotal Haematoma Following Hernial Repair

Dr Z

2024

TIJ

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Cremasteric artery is a branch of inferior epigastric artery supplying the cremaster muscle and coverings of the cord. The possible consequence of injury to this artery is scrotal haematoma. We present a case of haemorrhage from unexpected cresmastric artery injury post-hernioplasty treated with angioembolisation. To the best of our knowledge, this has not been reported in literature. A 66-year-old gentleman with left indirect inguinal hernia underwent a left inguinal hernioplasty in our institution with no immediate complications. However he presented to the emergency department the day after the procedure with complaints of rapidly worsening painful left scrotal swelling accompanied with symptoms of intestinal obstruction. Emergency laparotomy and re-do left hernioplasty was performed, revealing a strangulated inguinoscrotal hernia. Post-operatively, there was non-resolving scrotal swelling with a drop in the haemoglobin level; from 11.9g/dl to 8.5g/dl requiring packed cell transfusion. CT angiogram revealed active contrast extravasation from the left cremasteric artery. Angiographic run confirmed the finding and the left cresmatric artery was superselectively cannulated with a 1.9Fr microcatheter and embolization done with 0.5mm microcoil. Ultrasound scan 24-hour post-procedure showed patent proximal vessel. Clinically there was a reduction of the left scrotal swelling and the haemoglobin remained stable. Cremasteric artery courses laterally deep into the fascia transversalis entering the cord deep to the internal spermatic fascia to supply the cremaster muscle and coverings of the cord. This course renders the artery to be prone for injury during procedure such as hernioplasty; one of the possible consequences is scrotal haematoma. This artery is usually small in caliber and its identification is important for efficient and effective treatment. Angioembolisation is able to treat this injury with superior precision owing to its ability for localization and selective cannulation of the offending vessel.

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What is the reality in outpatient vs inpatient groin hernia repair? An analysis from the Herniamed Registry

Köckerling

Lorenz²,

Reinpold³

et al. 2021

Hernia

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Major Bleed Post Minimally Invasive Surgical Repair of Inguinal Hernia

Cited by 4 publications

References 11 publications

Encountering the corona mortis vessel during laparoscopic totally extraperitoneal mesh hernioplasty and its significance

Encountering the corona mortis vessel during laparoscopic totally extraperitoneal mesh hernioplasty and its significance

Angioembolisation of Cremasteric Artery for Scrotal Haematoma Following Hernial Repair

What is the reality in outpatient vs inpatient groin hernia repair? An analysis from the Herniamed Registry

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