Intra-abdominal and abdominal wall haematoma from 5 mm port insertion site in laparoscopic cholecystectomy

Trocar insertion is an essential and initial part in any laparoscopic procedure. Inadvertent abdominal wall vascular injury, leading to intra-abdominal bleeding or abdominal wall haematoma due to trocar insertion, may occur at this first step. We report here a case of uneventful laparoscopic cholecystectomy in a 44-year-old woman, which was followed later by large abdominal wall haematoma through the 5 mm trocar insertion site. Emergency laparotomy was needed to control the bleeding. Delayed abdominal wall haematoma can occur even with most lateral, 5 mm trocar insertions. Learning abdominal wall vascular anatomy, transilluminating the abdominal wall before trocar insertion and entering the abdominal cavity at a right angle may decrease the possibility of this complication.