Abstract
We treated a 73-year-old man who reported history of having undergone a Bentall operation for aortic dissection and stent grafting for a thoracoabdominal aortic aneurysm. He had been administered warfarin potassium for his history of atrial fibrillation. He presented to our hospital with a right inguinal swelling, which was diagnosed as a right inguinal hernia, The Lichtenstein procedure was performed under general anesthesia after preoperative heparinization. Heparin administration was resumed the day after surgery. He developed a marked superior to subcutaneous swelling the wound site 2 days postoperatively. Hematological findings showed a drop in his hemoglobin level and platelet count. Contrast-enhanced computed tomography revealed a rectus sheath hematoma and leakage of contrast medium. Because conservative treatment was considered difficult, we performed angiography, which revealed hemorrhage from the right-sided deep circumflex iliac artery, and arterial embolization with N-buty1 cyanoacrylate-lipiodol was performed. Subsequently, anticoagulant therapy was resumed, and no additional hemorrhage was reported during the 8-month postoperative follow-up. Although the development of rectus sheath hematomas following inguinal hernia surgery is rare, we report a patient in whom hemostasis could be achieved using interventional radiology.
