腹腔鏡手術の５mmポート挿入により腹壁血管損傷を来し、腹腔鏡下に止血を得た１例

抄録

Objective: One of the complications associated with port insertion in laparoscopic surgery is abdominal wall vascular injury. To prevent this, it is common practice to check the abdominal wall vessels using the transmitted light of the laparoscope. In this report, we describe a case of massive bleeding due to abdominal wall vessel injury despite such efforts and was discovered by laparoscopy.

Case: The patient was a 40-year-old woman, gravida 1 para 0, who came to our hospital because of abnormal uterine bleeding and dysmenorrhea. Uterine fibroids of 5 cm and 3 cm were found, and laparoscopic myomectomy was performed to treat her symptoms. After the surgery, pain, pallor, and anemia appeared. Contrast-enhanced computed tomography (CT) was performed, and the patient was diagnosed with abdominal wall vascular injury near the port wound in the left lower abdomen. Laparoscopic hemostasis and blood transfusion were performed, and the patient was discharged on the 9^th postoperative day.

Conclusion: Although the frequency of abdominal wall vascular injuries is decreasing, there is still no reliable method of prevention, and it is a complication that requires constant attention. In postoperative management, attention tends to focus on the more frequent complications, but it is necessary to share experience with complications so that even infrequent complications can be dealt with promptly.