This report describes the case of a 36-year-old woman who presented to our intensive care unit in profound refractory shock after a complicated laparoscopic cholecystectomy. Transoesophageal echocardiography showed an extrapericardial mass blocking venous return and computed tomography showed an intra-abdominal haematoma with displacement of the liver. The patient was diagnosed with extrapericardial tamponade caused by compression of the right atrium by the liver due to a large intra-abdominal haematoma. Decompression via explorative laparotomy was performed, resulting in a quick and full recovery of the patient. We conclude that extrapericardial tamponade should be considered in patients presenting with refractory shock after abdominal surgery.