Background: Delayed postoperative
bleeding after robot-assisted radical
prostatectomy (RARP) is a rare life-threatening condition. We present such a case wherein a patient developed
hemorrhagic shock from a ruptured
pseudoaneurysm arising from the epigastric artery and discuss its management. Case Presentation: A 71-year-old man with
prostate cancer underwent RARP. The
urethral catheter was removed on postoperative day 7; 80 minutes later, the patient suddenly lost consciousness and went into
shock. Enhanced CT revealed intra-abdominal
bleeding; however, the cause was unknown. Intraoperatively,
bleeding was observed from the anterior abdominal wall, which likely corresponded to the epigastric artery. However, this was controlled with monopolar
electrocautery. Because of unstable hemodynamics, hemostasis was immediately performed by
laparotomy, and
bleeding was noted from the previously coagulated right inferior epigastric artery. Therefore, the cause was considered to be the
rupture of a
pseudoaneurysm. Conclusion : Our experience suggests that monopolar
electrocautery may be inadequate for controlling
bleeding that may be encountered during RARP, possibly leading to
pseudoaneurysm formation, which may cause a delayed life-threatening
hemorrhage. Meticulous and precise hemostasis is key to avoiding this complication.