Catastrophic iatrogenic abdominal aorta haemorrhage during anterior resection

A woman in her 70s with hypertension, breast cancer and diverticulosis underwent laparoscopic anterior resection for a tubule-villous adenoma, converted to open Hartmann's with aorto-bi-iliac bypass due to a vascular injury. Intraoperative complications included haem-o-lok penetration of the calcified aorta, necessitating vascular team intervention. Postoperative issues included bilateral popliteal artery emboli requiring embolectomy and fasciotomy, and a parastomal abscess. Despite significant blood loss and complications, the patient recovered well and remains cancer-free. This case underscores the importance of early conversion to laparotomy in major vascular injuries and preoperative assessment for vascular calcification.