Laparoscopic intestinal injury: a review and case presentation

The incidence of laparoscopic primary trocar small-intestine injury is unknown. The case presented here differed from a typical clinical course in that only excessive periumbilical fluid leak was present postoperatively. Neither classic symptoms nor signs were present to justify laparoscopic trocar small-bowel perforations.

A 42-year-old woman (G2 P1011, height 5'4", weight 132 lb) underwent elective, diagnostic, and operative laparoscopy with a lysis of extensive abdominal-pelvic adhesions for chronic pelvic pain. Preoperatively, the patient was classified as being at increased risk for intestinal laceration or perforation at the time of Veress needle or primary trocar insertion due to her surgical history. For this reason, mechanical bowel preparation with GoLYTELY was carried out. No intraoperative complications were noticed. After surgery, external, excessive fluid leak from the periumbilical incision only was observed (the three 5-mm incisions, in the lower part of the abdomen, were dry). Initially, this event was interpreted as residual irrigation fluid leakage. The patient was closely monitored for bowel injury, and neither medical condition nor laboratory tests changed from base within the initial 48 h, although excessive fluid drainage from periumbilical area was persistent. Enough time elapsed from laparoscopic surgery for CO2 and irrigation-fluid absorption; therefore, additional studies were ordered (an abdominal upright x-ray was inconclusive for viscous perforation and gastrointestinal x-ray with a water-soluble contrast medium documented small-intestine perforation). Exploratory laparotomy with partial bowel resection was executed. Postoperative clinical course was uneventful, and no long-term sequel was observed.

1) Persistent excessive external fluid leak from the periumbilical area after laparoscopic surgery with no drainage from other incisional sides may suggest small-bowel injury. 2) latrogenic, internal-external canalization between the small intestine and the skin masked clinical symptoms and signs of small-intestinal injury. 3) Lack of classic symptoms, signs, or changes in pertinent laboratory data did not rule out small-bowel perforation.