Letter to Editor - Near Fatal Haemoperitoneum of Rare Origin Following Laparoscopic Sterilisation

A 27-year-old, multiparous lady underwent laparoscopic tubal sterilisation under local anaesthesia at a camp. She was sent back home two hours after the procedure. Later in the day, she developed giddiness and fainting and then presented herself to the gynaecological emergency unit of our hospital, five hours after the procedure. At initial examination, her pulse and blood pressure were not recordable and profound pallor was evident. Abdomen was distended and four quadrant abdominal paracentesis revealed free blood. Immediate laparotomy was performed with a midline vertical infraumbilical incision. At laparotomy, despite a 4000 ml haemoperitoneum, the uterus, adnexa, bowel and the great vessels were found to be normal and the Fallope rings were well applied. Examination of the anterior abdominal wall revealed a completely severed actively bleeding aberrant vessel, which was ligated at both the ends. This was a 6-mm wide unpaired branch of right inferior epigastric artery, coursing along the medial border of rectus muscle, between the muscle and the posterior lamina of rectus sheath. No other anomalies were detected. She made an uneventful recovery.