Injury of the corona mortis during vaginal tape insertion (TVT-Secur™ using the U-Approach)

We report a serious bleeding complication due to injury of the corona mortis following insertion of a transvaginal tape, TVT-Secur (TM) (Ethicon Women's Health, Sommerville, NJ, USA). The TVT-Secur (TM) was inserted using the U-Approach: the tape was pushed along the periost behind the arc of the pubic bone at an angle of 45A degrees. Surgery was unproblematic. Four hours after surgery, the patient showed shock signs; a CT scan revealed a 13.5 x 9.5-cm-sized retrosymphysic haematoma. Instant laparotomy with removal of the large haematoma, ligation of the bleeding corona mortis and administration of erythrocyte concentrates were necessary. The corona mortis is an anastomosis between the arteria obturatoria and the external iliac vessels or its branches that passes over the superior pubic ramus. Its prevalence and anatomical relation to the pubic bone are important to bear in mind when applying new surgical techniques.