Aortic injury during diagnostic pediatric laparoscopy.
Major vascular injury during laparoscopic procedures is a rare but catastrophic complication. We report a pediatric case of aortic laceration during the setup phase of diagnostic laparoscopy in a 5-year-old girl with recurrent abdominal pain. The Veress needle inserted below the umbilicus confirmed the proper placement by use of a saline-filled syringe. The abdomen was insufflated without difficulty. The first trocar was inserted at the same point as Veress needle. The video laparoscope was introduced, and a small amount of blood was seen in the abdomen. We converted the procedure to laparotomy immediately. There was a large retroperitoneal hematoma. The vascular laceration was identified at the origin of the iliac arteries. It was sutured with prolene 5/0. The girl was discharged without further complication on the 10th postoperative day. The incidence of major vascular injuries is 0.03% to 0.07%. The vessels most frequently involved are the aorta, the iliac arteries, the mesenteric vessels, and the vena cava. More than 400 cases have been reported in the literature, but only four of these involve pediatric patients. In the vast majority of cases, the complication took place during the setup phase of laparoscopy (75%), and were related to the introduction of either the Veress needle (30%) or the first umbilical trocar (43%), although the rate is opposite this in some studies.
Montero
M
M
Department of Pediatric Surgery, Children's Hospital Teresa Herrera, Complexo Hospitalario Juan Canalejo 15006, As Xubias 84, La Corua, Spain. mmontero@wanadoo.es
Tellado
M G
MG
Ríos
J
J
Méndez
R
R
Somoza
I
I
Pais
E
E
Vela
D
D
D001012:Aorta, Abdominal / Q000293:injuries; D002675:Child, Preschool; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D007083:Iliac Artery / Q000293:injuries*; D010535:Laparoscopy / Q000009:adverse effects*; D007813:Laparotomy; D012187:Retroperitoneal Space; D020535:Video-Assisted Surgery