Essay On Bowel Injury

Bowel injury is associated with potentially life threatening consequences if not promptly recognized and treated. Immediate intraoperative repair is recommended because diagnosis of an unrecognized bowel in postoperative period is difficult. Early imaging with computerized tomography (CT) of the abdomen and pelvis is vital, and immediate surgical exploration is required when a bowel injury has been identified.
Bishoff et al. performed a retrospective review in 915 patients who underwent laparoscopic urological procedures between July 1991 and June 1998 (42). Bowel perforation occurred in 0.2% of cases and bowel abrasion occurred in 0.6%. Most bowel abrasion injuries were recognized intraoperatively and repaired immediately. In 4 cases, perforation injuries were not recognized intraoperatively and patients developed peritonitis and severe sepsis; 2 patients subsequently died (42). The authors also reviewed 12 series of laparoscopic bowel complications in the literature and found that the combined incidence of laparoscopic bowel injury was 0.13%, and most injuries (69%) were not recognized at
reported 20 (1.1%) complications associated with injury to adjacent structures including 6 bowel injuries (24). 12 were associated with the use of monopolar electrocautery and in all 12 cases injury was not detected during surgery (24). Use of cold scissors or different energy sources, such as bipolar or ultrasonic energy was recommended. Minor thermal injuries may be managed with observation or with superficial suturing but major thermal injuries need a bowel resection with a 6 cm safety margin on either side before completing an end-to-end anastomosis (43). Nonthermal injuries are typically repaired by direct closure with suturing (23). Duodenal injuries most commonly occur during anteromedial dissection to the right kidney. Prevention of duodenal injury require careful dissection and Kocher’s maneuver to mobilize the duodenum away from the operative