Abdominal Wall Vascular Injury by Drain Insertion after Anterior Lumbar Spinal Fusion

Abstract

A 64-year-old gentleman presented with haemoglobin drop and an increase in fresh blood output in abdominal drain after anterior lumbar spinal fusion. Urgent re-exploration was performed, and injury to abdominal wall vessel during drain insertion leading to active bleeding was noted. Here, we report this rare case and summarize the characteristics of vasculature of abdominal wall, which may help reduce the possibility of this rare complication.

Vascular Anatomy and Variations of the Anterior Abdominal Wall – Significance in Abdominal Surgery

“…Additionally, the AAW could be separated into 9 regions, which are created by two vertical lines (through the midline of each clavicle) and two horizontal lines (one through the costal margin and one through the transtubercular plane). The regions are: right/left hypochondriac, right/left lumbar, right/left iliac, umbilical, hypogastric and epigastric (Gray et al, 2005;Netter, 2014). The nine regions are illustrated in Figure 1.…”

“…The Camper's fascia is a soft and movable adipose layer subjacent to the dermis, which inferior prolongation unites within the superficial fascia covering the labia majora. Additionally, the Camper's fascia passes above the inguinal ligament (without attaching to it) and continues with the superficial fascia of the thigh (Gray et al, 2005;Mahadevan, 2006;Netter, 2014;Farthing, 2018). Camper's fascia divides the skin from the muscles and plays an important role as a protector and an insulator to the deep organs of the abdomen (MacKay et al, 2022).…”

“…The linea alba is significantly thicker above the umbilicus as the rectus abdominis muscles lie closer from one other, whereas below the umbilicus the linea alba narrows progressively as the muscles diverge from one other. At the lower AAW, the linea alba has two attachments -one to the symphysis pubis and the other behind rectus muscles to the posterior surface of the pubic crest (also known as "adminiculum lineae albae" (Arslan, 2005;Gray et al, 2005;Mahadevan, 2006;Netter, 2014).…”

“…124 (2023) No. 2, p. 108-142 following ligaments attach to the umbilicus -median (urachus remnant), medial (obliterated umbilical arteries), lateral (inferior epigastric artery/vein) and the falciforme ligament (Arslan, 2005;Gray et al, 2005;Mahadevan, 2006;Netter, 2014) (Figure 3).…”

“…It is composed of nine abdominal layers, which consist of fascias, muscles, nerves and vessels (Mahadevan, 2006). Rich arterial and venous anastomoses from the superficial and deep vessels of the AAW are present (Gray et al, 2005;Netter, 2014). Therefore, physicians from surgical specialties regarding abdominal procedures should be familiar with the anatomy of the AAW.…”