Rectosigmoid obstruction after a uterosacral ligament suspension

Area of Science:

• Gynecology
• Surgical Complications
• Pelvic Reconstructive Surgery

Background:

• Vaginal hysterectomy with uterosacral ligament suspension (USLS) is a common procedure for pelvic organ prolapse.
• While generally safe, surgical complications can occur, necessitating prompt diagnosis and management.
• Colon obstruction is a rare but serious potential complication following pelvic reconstructive surgery.

Purpose of the Study:

• To report a rare case of colon obstruction secondary to uterosacral ligament suspension (USLS).
• To emphasize the importance of meticulous uterosacral stitch placement during USLS.
• To highlight potential surgical risks and management strategies in urogynecology.

Main Methods:

• Case report of a patient presenting with post-operative abdominal pain and distention.
• Diagnostic imaging including CT scan and rectal contrast study.
• Surgical intervention involving flexible sigmoidoscopy and diagnostic laparoscopy.

Main Results:

• A patient developed severe abdominal symptoms on post-operative day 2 after USLS.
• CT scan revealed colonic distention, and rectal contrast confirmed rectosigmoid junction obstruction.
• Laparoscopy identified right-sided uterosacral stitches causing colon obstruction, which resolved upon stitch release.

Conclusions:

• Uterosacral stitch placement during USLS can lead to colon obstruction due to kinking, particularly with a redundant or deviated colon.
• Prompt surgical intervention is crucial for diagnosing and managing such rare complications.
• Careful consideration of stitch placement is essential to optimize apical support and prevent injury to adjacent structures during USLS.