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Unexpected fatal outcome of laparoscopic inguinal hernia repair
Alžbeta Ginelliová1, Daniel Farkaš2, Silvia Farkašová Iannaccone3
1Medico-Legal and Pathological-Anatomical Department of Health Care Surveillance Authority, Letná 47, 040 01, Košice, Slovak Republic. e.ginelli@gmail.com.
Insights
A patient on warfarin experienced fatal bleeding after laparoscopic inguinal hernia repair. This case highlights the risks associated with routine surgery in patients with altered health status.
Area of Science:
- Surgery
- Pathology
- Pharmacology
Background:
- Inguinal hernias are common, with laparoscopic transabdominal pre-peritoneal (TAPP) repair being a standard procedure.
- Warfarin is an anticoagulant medication used to prevent blood clots.
- Patients on anticoagulation therapy may have an increased risk of bleeding complications.
Observation:
- A 60-year-old man on long-term warfarin therapy underwent TAPP inguinal hernia repair.
- The perioperative and postoperative periods were initially reported as uneventful.
- Autopsy revealed massive pre-peritoneal and inguinal hematoma, leading to hemorrhagic shock.
Findings:
- The cause of death was hemorrhagic shock secondary to bleeding at the TAPP repair site.
- No surgical mishap or injury to major vessels was identified.
- This is the first reported fatal outcome after TAPP repair in Slovakia.
Implications:
- Routine surgical procedures can have fatal outcomes in patients with specific health conditions.
- Careful patient selection and risk assessment are crucial for anticoagulated individuals undergoing surgery.
- This case underscores the importance of considering patient comorbidities in surgical risk stratification.
Abstract:
In this paper we report the autopsy findings of a long-term warfarinized 60-year-old man who died unexpectedly 2 days after undergoing laparoscopic transabdominal pre-peritoneal (TAPP) inguinal hernia repair. In his medical records it was stated that the perioperative and postoperative period was uneventful with no sign of bleeding and he was discharged the day after surgery. Autopsy revealed massive bleeding in the pre-peritoneal space at the surgery site and a massive left inguinal canal hematoma spreading through the spermatic cord to the left scrotum. There was no evidence of retroperitoneal bleeding. No sign of traumatic injury to the abdominal wall, major abdominal and pelvic vessels was revealed. The cause of death was hemorrhagic shock. We believe that this is the first documented case of fatal outcome after TAPP inguinal hernia repair in Slovakia. Inguinal hernias account for approximately two-thirds of all abdominal wall hernias. The reported case demonstrates that routine procedures such as TAPP hernia repair can have a fatal outcome, not due to any surgical mishap but because of the altered health status of the patient.
