Background: Trocar injury is a considerable complication of laparoscopic surgery. It is mostly noticed at the insertion or removal of trocars, and adequate measures can minimize potential injury. Late onset of hematoma arising from trocar injury is a rare condition.
Case: We performed a laparoscopy-assisted right salpingo-oophorectomy for a giant multilocular cystic tumor of the right ovary in a 42-year-old obese woman (body mass index: 29.6 kg/m²). No bleeding at the port sites was detected during trocar removal under laparoscopic guidance; however, two days after the surgery, we found a subcutaneous and intraperitoneal hematoma centering around one of the port sites, which was punctured by a 5-mm VersaStep™ bladeless trocar. We detected the injury of a vessel, which was probably one of the branches of inferior epigastric artery, near the port site.
Conclusion: It was difficult to detect the inferior epigastric artery or its branches at trocar insertion using a transparent laparoscopic technique in the obese patient; therefore, trocar removal should be carefully performed even when a 5-mm VersaStep™ bladeless trocar is used. Once the trocar injury is identified, during or after laparoscopic surgery, adequate measures, including laparotomy, must be undertaken to resolve it.