A 55-year-old man undergoes laparoscopic totally extraperitoneal (TEP) repair for a right indirect inguinal hernia. During dissection, he develops haemodynamic compromise; CT reveals a large retroperitoneal haematoma. The most likely injured vessel is:

• A Inferior epigastric artery
• B External iliac vein
• C Deep circumflex iliac artery
• D Corona mortis (aberrant obturator artery from external iliac) ✓

Explanation

The corona mortis ('crown of death') is an anastomotic vessel between the obturator and external iliac/inferior epigastric arterial systems, occurring in approximately 10–30% of patients. It runs close to the superior pubic ramus (medial to the femoral canal) in the space of Retzius and is particularly endangered during TEP repair when the preperitoneal space is developed medially near Cooper's ligament. Its injury causes catastrophic haemorrhage. The inferior epigastric artery is more lateral and typically avoided by the TEP approach. The external iliac vein can be injured but runs in a different anatomical region.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.