Laparoscopic bowel injury: Incidence and clinical presentation

Purpose: Bowel injury is a potential complication of any abdominal or retro peritoneal surgical procedure. We determine the incidence and assess the se quelae of laparoscopic bowel injury, and identify signs and symptoms of an unrecognized injury. Materials and Methods: Between July 1991 and June 1998 laparoscopic urologi cal procedures were performed in 915 patients, of whom 8 had intraoperative bowel perforation or abrasion injuries. In addition, 2 cases of unrecogniz ed bowel perforation referred from elsewhere were reviewed. A survey of the surgical and gynecological literature revealed 266 laparoscopic bowel perf oration injuries in 205,969 laparoscopic cases. Results: In our series laparoscopic bowel perforation occurred in 0.2% of c ases (2) and bowel abrasion occurred in 0.6% (6). The 6 bowel abrasion inju ries were recognized intraoperatively and 5 were repaired immediately. In 4 cases, including 2 referred from elsewhere, perforation injuries were not recognized intraoperatively and they had an unusual presentation postoperat ively. These patients had severe, single trocar site pain, abdominal disten tion, diarrhea and leukopenia followed by acute cardiopulmonary collapse se condary to sepsis within 96 hours of surgery. The combined incidence of bow el complications in the literature was 1.3/1,000 cases. Most injuries (69%) were not recognized at surgery. Of the injuries 58% were of small bowel, 3 2% were of colon and 50% were caused by electrocautery. Of the patients 80% required laparotomy to repair the bowel injuries. Conclusions: Bowel injury following laparoscopic surgery is a rare complica tion that may have an unusual presentation and devastating sequelae. Any bo wel injury, including serosal abrasions, should be treated at the time of r ecognition. Persistent focal pain in a trocar site with abdominal distentio n, diarrhea and leukopenia may be the first presenting signs and symptoms o f an unrecognized laparoscopic bowel injury.