Laparoscopic Treatment of Inguinal Haemorhage after Prescrotal Orchiectomy in a Dog

Introduction
Serious complications after orchiectomy are rare, since most can be prevented using good surgical technique. Postoperative haemorrhage may be serious, particularly when it occurs within the abdomen and goes unnoticed. Treatment of the haemorrhage can be conservative or surgical, depending on the localization and severity. This case describes the use of laparoscopic surgery to locate the bleeding vascular pedicle and achieve hemostasis.

Case history
A 1-year-old male Jack Russell terrier was presented to the Faculty of Veterinary Medicine at Ghent University with anaemia, lethargy and a large prescrotal hematoma after elective prescrotal orchiectomy. Previous emergency exploration by the referring vet had not been successful in locating the area of bleeding. After stabilizing the cardiorespiratory function, laparoscopic exploration of the abdomen was performed. The inguinal nature of the haemorrhage could be established and after retracting the spermatic cord into the abdomen haemostasis was easily performed using a bipolar sealing device. Evacuation of the prescrotal hematoma afterwards was simplified by the achieved hemostasis.

Discussion
In the surgical treatment of postoperative haemorrhage a (pre)scrotal approach is advocated when haemorrhage is located near the scrotum, and an abdominal approach is used for abdominal or inguinal haemorrhage. The caudal abdomen can be approached by traditional laparotomy or laparoscopy. Performing a laparoscopic exploration of the abdomen offers all the advantages (magnification, superior lightening, adequate working space, complete abdominal exploration) without the disadvantages of a mini-laparotomy. Ligation of the spermatic cord can easily be performed using different techniques. Minor bleeding can be dealt with, using irrigation/suction apparatus. Extensive bleeding, however, would be an indication to convert to open surgery. The authors believe laparoscopic surgery can be the preferential alternative for caudal midline celiotomy to locate and ligate a bleeding vascular pedicle in case of abdominal or inguinal haemorrhage after orchiectomy.