A case of hemorrhagic shock following injury to a patent paraumbilical vein due to alcoholic cirrhosis during trocar insertion

Abstract

　In laparoscopic surgery, abdominal wall vascular injury could occur as a complication of trocar insertion, which can sometimes cause serious bleeding. We report a case of hemorrhagic shock due to trocar injury to recanalization of paraumbilical vein caused by cirrhosis of the liver. A 53-year-old woman, gravida 2 para 1, had a history of alcoholic liver disease. MRI revealed right adnexal abscess, for which we performed laparoscopic salpingo-oophorectomy. Intraoperatively we observed irregularities of the liver surface. Surgery was completed with drainage of the right adnexal abscess. After extubation, a sudden drop in blood pressure and tachycardia were observed, and the patient was in shock. Transabdominal ultrasonography revealed an abdominal wall hematoma at the port insertion site in the midline of the lower abdomen, and consequently she underwent additional operation for hemostasis. Hemorrhage from a torn paraumbilical vein was observed and ligated and achieved hemostasis. Postoperative contrast-enhanced CT revealed splenomegaly and patency of the paraumbilical vein, which together with the intraoperative findings led to the diagnosis of alcoholic cirrhosis and associated portal hypertension. Before surgery, it is important to evaluate the patient's medical history and perform preoperative imaging with attention to abdominal wall abnormalities. In laparoscopic surgery, bleeding from veins may be masked; therefore, confirmation of hemostasis should be carefully performed.