Management of laparoscopic-related bowel injuries

Abstract

Every measure should be taken to avoid the occurrence of bowel injury during laparoscopy. Intraoperative or early postoperative diagnosis and proper management of laparoscopic-induced bowel injuries can minimize morbidity and mortality and yield a better prognosis.

Bowel injury as a complication of laparoscopy

“…The small intestine was most frequently affected (227 injuries; 55·8 per cent); of these injuries, 38 involved the duodenum. All duodenal injuries were complications of laparoscopic cholecystectomy 8,9,15,18,20,22,25,32,33 . The large intestine was damaged 157 times (38·6 per cent).…”

Management of Descending Duodenal Injuries Secondary to Laparoscopic Cholecystectomy

“…A delay in diagnosis may result in sepsis and peritonitis, contributing to the relatively high associated mortality [8, 9]. The overall mortality rate of duodenal perforation secondary to laparoscopic cholecystectomy ranges from 8.3% [4] to 16% [10], but mortality varies from 30 to 75% when sepsis results in a multiorgan failure [2, 11, 12]. More than half of laparoscopic bowel injuries reported in literature were due to electrocautery damage [6] or when the dissection of Calot’s triangle was difficult, either because of adhesions or because of distorted anatomy [13].…”

“…Croce et al [14] also suggest avoiding the use of sharp-pointed suction/irrigation devices to retract the duodenum. The risk of complication in the course of laparoscopic surgery is said to relate to the operator’s experience with the procedure and the difficulty of the operation [4, 7, 15, 16] but may also occur in the hands of experienced surgeons [2, 17, 18]. …”

“…Nevertheless, the widespread application of laparoscopic procedures has been associated with the occurrence of serious complications, some of which are typical of laparoscopic access and not common when the same procedure is carried out using open surgery [1]. Injury to the biliary tree, small bowel and major vessels represent the main complications of laparoscopic cholecystectomy and range from 0.3 to 7% [2, 3]. …”

Perseverance pays: A complicated case of post laparoscopic cholecystectomy duodenal injury

“…In one series of four cases of post LC duodenal injuries, three patients died. 5 We report a case of a post LC duodenal injury that was referred to us which was complicated by other events and was successfully managed.…”