Gynecologist Causes Bowel Perforation During Laparoscopic Surgery

Injuries to the bowel are common during open gynecological surgery, however, less common when done laparoscopically. Any delay in diagnosing a bowel perforation can lead to serious fecal peritonitis and even death. If a patient is experiencing pain, tachycardia, and fever following surgery, bowel injury should be suspected, warranting immediate consultation with a general surgeon. The diagnosis can be established postoperatively as free intra-abdominal air on radiograph. If this is found, a laparotomy is indicated at this time. Injury to the bowel may result from insertion of the pneumoperitoneum needle, placement of the laparoscopic trocar, electrosurgical injury, or trauma during dissection. Symptoms from penetrating trauma generally manifest within twelve to thirty-six hours, but may occur up to five or seven days later. Presumably, patients who present after several days have experienced either delayed necrosis of damaged bowel, or had a leak which temporarily sealed off. Selective observation of patients with abdominal injury consists of serial abdominal examination, repeat laboratory studies and repeat abdonimal imaging (usually CT scan), as needed. The most important management is the use of frequent serial abdominal examinations, ideally conducted hourly. Clinical signs during the period of observation that suggest the presence of a bowel injury include progressively worsening abdominal pain, hemodynamic instability, or intolerance of oral intake. Monitoring the white cell count may contribute to the clinical picture if significantly or persistently elevated.