Testicular Artery Hemorrhage after Inguinal Hernia Repair

Sheikh, Ahmed; Klyde, David; Contractor, Sohail

doi:10.1016/j.jvir.2013.12.003

Cited by 4 publications

(4 citation statements)

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“…Complications of inguinal hernia surgery include injury to bladder, bowel, vas deferens, and vasculature of the inguinal canal (1). Vascular injury during inguinal hernia repair usually presents as scrotal haematoma and can occur by damage to any of the following vessels: rectus muscle vessel, inferior epigastric vessels, venous plexus at the pubic symphysis, aberrant obturator vein, testicular vessels, and iliac vessels (1). CT angiography should ideally be performed first, and the pelvic vasculature is studied to identify the offending vessel, in this case, the cremasteric artery.…”

Section: Discussionmentioning

confidence: 99%

“…The management of cremasteric artery injury may vary depending on the severity of the injury and the presence of other complications. Treatment options for cremasteric artery injury include surgical ligation of the artery, surgical repair of the damaged artery, and endovascular techniques such as angioembolisation (1,3).…”

Section: Discussionmentioning

confidence: 99%

“…Angioembolisation is a suitable treatment option due to its ability to accurately localise and selectively cannulate the offending vessel (1). It is also able to map the collateral vessels; in this case the testicular artery (a branch of the aorta) and artery to ductus deferens (branch of superior vesical artery) (1,2). This information is important in determining the safest level of embolisation (distal versus proximal) and the safest embolic agents to use.…”

Section: Discussionmentioning

confidence: 99%

“…This information is important in determining the safest level of embolisation (distal versus proximal) and the safest embolic agents to use. In view of the rich collateral supply in the inguinal canal and the scrotum, precise superselective catheterisation of the vessel until the point of haemorrhage and the utilisation of microcoils as the embolic agent of choice to protect the collaterals and to avoid complications, particularly testicular ischaemia, are recommended (1). Angioembolisation has several advantages over other treatment options, including its precision, minimally invasive nature and high success rate (1).…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%