Introduction- Risk associated with laparoscopic vascular injuries is 0.1 %. This paper presents a case report of a life-threatening complication of aortic puncture and its management while trocar insertion for laparoscopic hysterectomy.

Case capsule- A 48-year old woman admitted to the hospital for laparoscopic hysterectomy. Preoperative physical findings and laboratory data were normal. Following the administration of general anaesthesia pneumoperitoneum established and trocar was inserted.

A sudden fall in blood pressure was noted, after which pulse and blood pressure was not detected. Resuscitation measures were initiated and simultaneously evaluated for the cause. Laparoscopic inspection revealed a full of blood field, a major vessel injury suspected. Resuscitation was continued by securing another two 16 gauge cannulae. Hemodynamics were stabilized with HES, RL, whole blood and ionotropic support.

Meanwhile called for vascular surgeon and informed to the blood bank for massive transfusion. A mid line laparotomy was performed and deep pressure was applied over the bleeding site until stabilization of patient. A defect was noted just above the bifurcation of abdominal aorta and repaired. A total of eight units of whole blood, two units of FFP and one unit of packed cells were transfused. Patient was stabilized and shifted to ICU for observation then discharged after six days

Conclusion- Anaesthesiologist should be vigilant concerning the very real threat of vascular injury during laparoscopy, and immediate recognition and resuscitation is most important. Presenting Author (reg no- 482)