Delayed recognition of major vascular injury during laparoscopy

We report an unusual case of left common iliac artery and vein injury during laparoscopy. The injury was recognized 3 h after the completion of the laparoscopy. The patient was promptly treated by explorative laparotomy and repair of the lacerated vessels. Major vascular injury during laparoscopy is usually caused by the Verres needle or the first laparoscopic trocar. Failure to recognize the injury during the laparoscopic procedure itself can be attributed to the intraperitoneal CO2 pressure compressing the bleeding vessels and to the decreased venous return caused by the steep Trendelenburg position. Major vascular injury should be recognized as early as possible since it is a life threatening condition that necessitates immediate and prompt treatment.