Postoperative hemorrhage due to avulsion of perihepatic adhesions after pneumoperitoneum

Serious laparoscopic injury is rare, occurring in less than 1/1000 procedures. To our knowledge, no liver injuries have been reported to date, but avulsion of hepatic adhesions may be a source of postlaparoscopic bleeding. A woman with chronic pelvic pain unresponsive to medical management underwent an uncomplicated diagnostic laparoscopy with extensive pelvic adhesiolysis. Adhesions of Fitz-Hugh-Curtis syndrome were seen over the right lobe of the liver. At the completion of the procedure no bleeding was noted, and the patient was discharged to home in stable condition. She returned 12 hours later with a significant hemoperitoneum necessitating laparotomy. It is important to consider this as a source of bleeding after laparoscopy in a patient with perihepatic adhesions.