A 55-year-old man undergoes laparoscopic totally extraperitoneal (TEP) repair of a right inguinal hernia. During dissection, bleeding from an unnamed vessel is encountered medially in the space of Retzius. The vessel most likely injured is:
- A Inferior epigastric artery
- B Obturator artery (abnormal obturator artery, 'corona mortis') ✓
- C External iliac artery
- D Deep circumflex iliac artery
Correct answer: B. Obturator artery (abnormal obturator artery, 'corona mortis')
Explanation
The 'corona mortis' (crown of death) refers to the anastomosis between the obturator and external iliac or inferior epigastric vessels lying on the superior pubic ramus. An abnormal obturator artery arising from the inferior epigastric is present in 30–40% of patients and crosses the femoral ring. During TEP dissection, inadvertent injury to this vessel in the medial preperitoneal space can cause life-threatening haemorrhage, earning the term corona mortis.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.