Which of the following is NOT listed as a common source of unrecognized bleeding during laparoscopy?

• A. Injury to vessels or organs away from the operative field
• B. Tamponade of venous bleeding by pneumoperitoneum
• C. Injury to the spleen during removal
• D. Trocar injury to abdominal wall vessels

Answer: (C)

Bleeding that isn’t immediately visible in the operative field often arises from sources that are hidden or masked once the laparoscopy begins. Vessels or organs injured away from where you’re working can bleed into the peritoneal cavity without being seen right away. The pneumoperitoneum itself can temporarily tamponade venous bleeding, making it harder to recognize until the gas is released or the pressure changes. Trocar entry can injure abdominal wall vessels, and those injuries may bleed into the tract or concealed areas, delaying recognition. In contrast, injury to the spleen during removal is typically identified during or soon after manipulation of the organ—if the spleen were injured, the bleed would usually be evident when you inspect or extract the organ, so it’s not classically considered a source of unrecognized bleeding.