Abstract
Obesity is a well-known risk factor for increased perioperative morbidity. As surgeons see higher volumes of obese patients, it is important to recognize how an elevated body mass index can impact even the most basic surgical steps, such as patient positioning. This case report describes an iatrogenic injury to the external iliac artery in a morbidly obese patient caused by an abdominal trocar during suprapubic catheter insertion secondary to malrotation of the bony pelvis. It highlights the importance of recognizing the impact of obesity on patient positioning.