Laparoscopic Repair of Small Bowel Injury in Penetrating Abdominal Trauma

Abstract

A role for laparoscopy in the management of selected trauma patients is now possible. We report a case of a patient with a stab wound and a bowel perforation who underwent diagnostic and laparoscopic treatment.

Diagnostic and Therapeutic Laparoscopy for Stab Wounds of the Anterior Abdomen

“…Small bowel and colonic injuries can be safely repaired with either a totally laparoscopic technique or a laparoscopy-assisted technique. 22,23,25,26 However, conversion is recommended when occult bowel injuries cannot be ruled out with certainty.…”

Therapeutic Laparoscopy for Blunt Abdominal Trauma with Bowel Injuries

“…These include autotransfusion of hemoperitoneum 8 ; stapling or suturing of stomach and diaphragmatic injuries 7 ; splenorraphy, hepatorraphy, cautery, and topical hemostasis of spleen and liver injuries 7,[9][10][11] ; reduction of omental herniation 12 ; laparoscopically assisted sigmoid colostomy 13 ; control of mesenteric bleeding 14 ; cholecystectomy 7 ; gastrotomy closure 7 ; bladder laceration repair 3 ; drainage of the abdomen by laparoscopically placed drains 7 ; drainage of peripheral pancreatic duct injury 15 ; and repair of a stab wound to the small bowel. 16 The lack of popularity of laparoscopy as a therapeutic tool in trauma patients may be explained by the widely variable experience of surgeons in both advanced laparoscopy and trauma care, the longer operative time required, and the additional costs associated with repairing complex intra-abdominal injuries laparoscopically in busy urban trauma centers.…”

“…A careful and systematic exploration of the abdominal cavity is key to the successful use of laparoscopy in the setting of abdominal trauma, as reported by Gorecki et al 3 Bowel injuries can be repaired with sutures or staplers laparoscopically or during open surgery with strategic incision, depending on the extent and type of injury and the surgeon's experience. 16 The limited potential for exploring retroperitoneal structures should be reevaluated in the light of recent advances in elective laparoscopic surgery involving these organs. 15,[17][18][19][20][21][22] An experienced laparoscopist with extensive experience in the field of trauma can apply laparoscopy in the setting of blunt abdominal trauma for the definitive operative repair of bowel injuries.…”

Laparoscopic management for spontaneous jejunal perforation caused by nonspecific ulcer: A case report

“…Furthermore, its diagnostic and therapeutic capabilities allow for a timely diagnosis without therapeutic delay and avoidance of unnecessary laparotomy [12] . However, the clinical potential of laparoscopy for this condition has not been thoroughly discussed because clinical experience is limited [13] . Spontaneous perforation of the small intestine may also be a good indication for laparoscopic management.…”