IP141. Aortic Penetration by Veress Needle During Laparoscopic Abdominal Access

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Laparoscopic abdominal surgery is one of the most common procedures performed in the United States. While there are many advantages to laparoscopic surgery, one of the most severe complications is injury to one of the major retroperitoneal vessels, occurring in 0.3% to 1.0% of procedures. This case reports details a successful rescue after iatrogenic aortic penetration. A healthy 21-year-old woman, weighing 42 kg, with a body mass index of 15.9, presents for elective right ovarian cystectomy via laparoscopic approach. The patient was intubated, positioned, prepared and draped and a Veress needle was used for initial entry below the umbilicus and the abdomen insufflated. Next, a 5-mm port was introduced under direct visualization, once in the abdomen large amounts of blood were noted in the pelvis and a second trocar was introduced. Given profound bleeding. the decision was made to proceed to laparotomy as the vital signs decompensated and massive transfusion protocol was initiated, stabilizing the patient while manual control of hemorrhage was obtained and vascular surgery was consulted. Upon arrival to the operating room, a retractor was placed with the retroperitoneum exposed over the infrarenal aorta. A puncture was noted 2 cm proximal to the aortic bifurcation and was closed with interrupted Prolene sutures, hemostasis obtained, viscera run ruling out further injury, the abdomen was closed and the patient transferred to the intensive care unit for further resuscitation after an estimated 2.5-L blood loss. The postoperative course was complicated by ileus, which resolved with nasogastric decompression and the patient was discharged home postoperative day 8. At the 2-month follow-up patient has resumed normal activities. Although aortic injury during laparoscopy is rare, it is potentially fatal and care must be taken to avoid this complication. When major vascular injury is suspected early recognition and treatment is of utmost importance to decrease morbidity and mortality.