Conservative management of an iliac artery injury during laparoscopic appendectomy: a case report

Introduction Major vascular injuries related to trocar insertion during laparoscopic appendectomy in children are exceptionally rare, yet they constitute one of the most feared complications. Notably, reports describing conservatively managed iliac vessel injuries in the pediatric population are lacking. Case Presentation A 12-year-old boy presented with a 24-hour history of abdominal pain. Examination revealed localized right iliac fossa tenderness, and ultrasound demonstrated a non-compressible 8-mm appendix. A three-port laparoscopic appendectomy was performed. Immediately after suprapubic trocar insertion, brisk arterial bleeding was observed. The bleeding site was identified and controlled with gauze compression, revealing a pinpoint injury to the right iliac artery and a non-expanding retroperitoneal hematoma. Distal limb perfusion remained adequate, as confirmed by pulse oximetry. After ten minutes of continuous compression, hemostasis was achieved. The appendectomy and partial omentectomy were completed, and no further bleeding was observed after releasing the pneumoperitoneum. Postoperatively, the patient remained hemodynamically stable, with no signs of limb ischemia. Doppler ultrasound on postoperative day five and at one-month follow-up showed normal arterial flow without thrombosis or pseudoaneurysm. Conclusion In hemodynamically stable children with a small, rapidly controlled iliac artery lesion and preserved distal perfusion, non-operative management supported by close monitoring and serial Doppler ultrasound may be a safe alternative to immediate open vascular repair.