QuizMe 19

Bowel Injury

You are performing a laparoscopic myomectomy on a 40 yr old woman for a leiomyoma not responding to medical management. During the operation, you noticed that your monopolar scissor has come into direct contact with the colon

You can appreciate a 1cm area ofwhite blanching in the region ofcontact with no apparent bowel spillage.

  • Watchful waiting with intraperitoneal drain
  • Oversew the blanched area in two layers
  • Purse string suture beyond the margins of
    blanching
  • Bowel resection with temporary diverting
    colostomy
  • Segmental bowel resection with
    reanastomosis

segmental bowel resection with reanastomosis

Although a rare complication of laparoscopic surgery, bowel injury may have a significant impact on morbidity and mortality of patients.Clinical outcomes are greatly improved with intraoperative recognition and management of such injuries.
Electrosurgical injuries are often denoted by blanching over the affected area, however, the area of damage is usually larger than can be appreciated with inspection due to delayed damage by coagulative necrosis.

Superficial injuries to the serosa, with intactmuscular and mucosal layers, may be managed with purse string closure. As a result of the inherent difficulty in assessing the extent of an electrosurgical injury, it should be assumed that the full thickness has been injured, calling for segmental resection and occasionally a diverting colostomy.

A colostomy is appropriate in cases with multiple bowel injury or significant contamination due to bowel spillage.
Bowel injuries that are not secondary to electrosurgical methods can be managed by oversewing the injured area with two layers.

  • Llarena NC, Shah AB, Milad MP. Bowel injury in gynecologiclaparoscopy: a systematic review.Obstet Gynecol. (2015)doi:10.1097/AOG.0000000000000855
  • Hui-Yu Huang, Chih-Feng Yen, Ming-Ping Wu,Complications of electrosurgery in laparoscopy,Gynecology and Minimally Invasive Therapy,https://doi.org/10.1016/j.gmit.2014.05.004.
  • Ulker, K., Anuk, T., Bozkurt, M., &Karasu, Y. (2014). Large bowel injuries during gynecological laparoscopy. World journal of clinicalcases,https://doi.org/10.12998/wjcc.v2.i12.846
  • Charles Chapron, Fabrice Pierre,Yahia Harchaoui, Sylvie Lacroix,Sandrine Béguin, Denis Querleu,Jacques Lansac, Jean-BernardDubuisson, Gastrointestinal injuries during gynaecological laparoscopy, Human Reproduction,https://doi.org/10.1093/humrep/14.2.3
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