Mechanism, management, and prevention of laparoscopic bowel injuries

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.

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.

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.

Suspected bowel injury following laparoscopy mandates early laparotomy to avoid life-threatening complications.