INTRODUCTION:
This study follows a case of a right ovarian cystectomy gone wrong. Ninety studies published between 1972-2014, representing 474,063 gynecologic laparoscopies. Six hundred and four bowel injuries were reported for an incidence of 1 in 769. The rate of bowel injuries was dependent on the type of procedure. The small bowel happens to be the most frequently injured in the gastrointestinal tract, with about 166 of 354 (45%) of the cases. The majority of these injuries were due to veres needle or trocar placement with about 201 of 366 (55%) (Llarena N.C et al 2015). This review is to evaluate the gastrointestinal complications that accompanied a trocar induced injury during a gynecological procedure.
CASE DESCRIPTION/METHODS:
A 28-year-old female presented to the ED with septic shock. History obtained from relative stated the patient had a right ovarian cystectomy performed a week before ED visit. Post-op, the patient had increasing abdominal pain which worsened until EMS was called. An abdominal ultrasound showed central vowel dilation predominantly in the small bowel in correlation with ileus. CT abdomen showed free air throughout the abdomen large amount of fluid including the edge of the liver with infarcts in the Liver and spleen. Comprehensive Metabolic Panel showed AST- 5974, ALT- 2472, LDH- 1195 Total bilirubin- 1.5, direct bilirubin- 1.91, Amylase- 155. Complete Blood Count with WBC- 20.70. Coagulation with INR- 2.39, Fibrin > 700. The above test after consultation with specialists indicated Ischemic hepatitis “shock liver” with very strong indications due to hepatic infarction as a result of hemodynamic instability (Friedman L.S et al 2018). Other complications included small bowel ileus, peritonitis due to perforation and systemic involvement as a result of shock.
DISCUSSION:
In conclusion, gastrointestinal complications are rare after a laparoscopic procedure. Irrespective of their frequency can result in mortality. The best approach lies in the surgical technique and experience. Early recognition is the best way to avoid further complications as a delay could result in sepsis and untimely death. In an event of a suspected gastrointestinal injury, general surgical consultation should be sought, and a management strategy implemented. (Karadag M.A et al 2015).
