Acute bilateral external iliac artery occlusion following a laparoscopic incisional hernia repair

Acute iliac artery thrombosis is a rare complication of laparoscopic surgery that represents a significant risk to limb and life. This case describes an uncommon instance of acute-on-chronic external iliac artery thrombosis presenting immediately after laparoscopic gastrointestinal surgery. While rare, this presentation highlights an important perioperative complication in patients with underlying vascular disease.A man in his early 60s underwent elective laparoscopic ventral hernia repair. Postoperatively, he woke with severe left calf pain. Both lower limbs were pale, cool and pulseless. CT angiography revealed bilateral external iliac artery occlusion. This complication was successfully managed with open bilateral external iliac thrombectomy, angioplasty and stenting.While venous thromboembolism, acute compartment syndrome and iatrogenic vessel injury are well-recognised vascular complications of laparoscopic surgery, there is limited literature describing arterial thrombosis. As acute limb ischaemia becomes an increasingly recognised complication of laparoscopic gastrointestinal surgery, surgeons should consider implementing preoperative and postoperative screening to minimise the risk of serious adverse outcomes.