Early postoperative small bowel obstruction after laparoscopic myomectomy

Area of Science:

• Gynecologic surgery
• Minimally invasive surgery
• Surgical complications

Background:

• Robotic-assisted laparoscopic myomectomy is a minimally invasive approach for uterine fibroids.
• While generally safe, potential complications require careful consideration and management.
• Early recognition of postoperative complications is crucial for optimal patient outcomes.

Observation:

• A 35-year-old woman developed small bowel obstruction two days after robotic myomectomy.
• The obstruction was caused by fibroid fragments that had implanted on and kinked the small bowel.
• Conservative management for four days failed to resolve symptoms.

Findings:

• Exploratory laparotomy was performed to lyse adhesions and remove implanted fibroid fragments.
• The patient experienced clinical resolution of small bowel obstruction symptoms.
• No bowel resection was necessary, preserving intestinal integrity.

Implications:

• This case underscores the importance of meticulous removal of all morcellated tissue during myomectomy to prevent ectopic implantation.
• Prompt diagnosis and surgical intervention are key to managing early postoperative small bowel obstruction.
• Preventing such complications can avoid the need for intestinal resection and reduce long-term morbidity.