Pseudoaneurysm: A complication of laparoscopic inguinal hernia repair

Laparoscopic inguinal hernia repair has gained importance during last few decades, because of its several advantages. However, it has its own set of complications, which can be avoided by following the basic anatomical principles of laparoscopic inguinal hernia repair.

An 85-year-old male patient, developed a painless intraabdominal lump following laparoscopic inguinal hernia repair. Clinical and radiological evaluation was suggestive of pseudo aneurysm. Intra operative findings revealed a pseudo aneurysm arising from the right deep circumflex iliac artery. Excision of the pseudo aneurysm with incorporated mesh along with orchidectomy followed by fascial repair was performed.

Pseudo aneurysm refers to a defect in an arterial wall, which allows communication of arterial blood with the adjacent extra-luminal space. Blood extravasates out of the artery, which is contained by surrounding soft tissue and compressed thrombus that forms a cavity or sac. With the increasing utilization of percutaneous arterial interventions worldwide, iatrogenic arterial injury has become the predominant cause of pseudo aneurysm formation. Here we report a case on pseudo aneurysm arising from deep circumflex iliac artery following laparoscopic inguinal hernia repair. This complication can be avoided by following the basic principles of surgical anatomy of the pelvis and groin as viewed through the laparoscope.

Pseudo aneurysm complicating laparoscopic inguinal hernia repair is a rare occurrence. Injury to seemingly small artery can lead to evolution of pseudoaneurysm. Adherence to surgical principle will avoid such a complication.