Rectosigmoid obstruction after a uterosacral ligament suspension

A woman in her 40s presented on post-operative day 2 following vaginal hysterectomy and uterosacral ligament suspension (USLS) with severe abdominal pain, distention and emesis. A distended colon was seen on CT, and rectal contrast confirmed complete obstruction at the rectosigmoid junction. She was taken urgently to the OR by the general surgery, urogynecology and reconstructive pelvic surgery teams for flexible sigmoidoscopy and diagnostic laparoscopy, where the right-sided uterosacral stitches were found to obstruct the colon. The obstruction resolved after releasing the right uterosacral stitches. We postulate that the obstruction resulted from kinking of the colon, which was noted to be redundant and right-deviating. This case highlights important considerations regarding uterosacral stitch placement during USLS to optimise both apical support and protection of nearby structures.