[Wounding of an iliac artery during celioscopy]

Vascular accidents during celioscopy are rare but potentially serious. Arterial injuries usually involve the aortic bifurcation and are generally recognized and treated as emergencies. In the present case, a transfixing wound of the right common iliac artery provoked by a trocar during gynecological celioscopy in a 36 year old woman was diagnosed secondarily, the posterior orifice being unrecognized during laparotomy to control hemorrhage. A false iliac artery aneurysm was detected 2 months later when she presented signs of a compressive retroperitoneal hematoma confirmed by arteriography and scan images. The common iliac artery was ligatured through a right retroperitoneal approach with extra-anatomical revascularization by a crossed iliofemoral venous shunt. The postoperative course was uncomplicated apart from a right cruralgia sequela. Immediate circumferential dissection for treatment of aortic bifurcation injuries is recommended, to avoid missing a transfixing wound, and to allow direct restoration usually by simple suture. In contrast, secondary treatment is complex, raises problems of arterial reconstruction, and cannot always prevent functional sequelae.