Background: 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 morbi
dity and mortality. Methods: We reviewed the mechanism and management
of 10 instances of bowel injury known to have been encountered in a se
ries of 4672 laparoscopic procedures performed at our hospital over th
e past 5 years. Results: 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 unre
cognized until 2 to 14 days after the procedure. One patient died of m
ultiple organ failure on the third day after laparoscopy. Operative ma
nagement 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. Conclusions: Suspected bowel injury follow
ing laparoscopy mandates early laparotomy to avoid life-threatening co
mplications.