Perforation of the Pregnant Uterus during Laparoscopy for Suspected Internal Herniation after Gastric Bypass

Abstract

We report perforations of a pregnant uterus during laparoscopy for suspected internal herniation after gastric bypass at 24 weeks of gestation. Abdominal access and gas insufflation were achieved by the use of a 12 mm optic trocar. An additional 5 mm trocar was positioned. The perforations were handled by suturing following laparotomy and mobilisation of the high located uterus. The uterine fundus was located in the subcostal area. Internal herniation was not verified. A cesarean section was made 6 weeks later due to acute low abdominal pain. During delivery the uterus was found normal. At 5 months of age the child has developed normal and seems healthy. Optical trocars should be used with caution for abdominal access during laparoscopy in pregnancy. Open access should probably be preferred in most cases. Accidental perforations of the uterine cavity may be handled in selected cases with simple closure even following the use of large trocars under close postoperative surveillance throughout the pregnancy.

Inadvertent Perforation of a Gravid Uterus During Laparoscopy

“…Buser 4 published a retrospective analysis of 36 laparoscopic surgeries performed on pregnant women over a 12-year period by a single surgeon and noted one case that was complicated by uterine perforation during placement of a blunt trocar. Mala et al 5 described a case of a pregnant woman undergoing laparoscopy at 24 weeks' gestation due to concern for internal herniation of her roux-en-Y gastric bypass. During laparoscopic entry with an optical trocar, the gravid uterus was inadvertently perforated and a fetal foot could be seen.…”

“…During laparoscopic entry with an optical trocar, the gravid uterus was inadvertently perforated and a fetal foot could be seen. 5 Friedman et al 6 reported another case in which a 21-week pregnant uterus was punctured with a Veress needle which resulted in spontaneous rupture of membranes and subsequent loss of the pregnancy. These cases highlight the need for obstetricians to be involved in preoperative planning of pregnant patients undergoing laparoscopic surgery.…”