Mechanism, management, and prevention of laparoscopic bowel injuries

Background: Inadvertent injury to the bowel is a rare but potentially fatal complication of laparoscopy, Such injury often goes unrecognized at the time of the procedure and only later is manifest by high morbidity and mortality. Methods: We reviewed the mechanism and management of 10 instances of bowel injury known to have been encountered in a series of 4672 laparoscopic procedures performed at our hospital over the past 5 years. Results: The usual causes of injury to the bowel wall were thermal burns, sharp dissection, and needle punctures, Six of the injuries were readily evident and treated immediately; four were unrecognized until 2 to 14 days after the procedure. One patient died of multiple organ failure on the third day after laparoscopy. Operative management in nine cases required simple closure or segmental resection. A high index of suspicion and vigilant physical examination were the keys to early recognition of bowel injury; laboratory and radiographic findings were nonspecific. Conclusions: Suspected bowel injury following laparoscopy mandates early laparotomy to avoid life-threatening complications.