10 Small bowel entrapment during pelvic reconstructive surgery

Abstract

The objectives of this video are to describe a case of a small bowel strangulation resulting from bowel entrapment within a uterosacral ligament suspension (USL) suture, to discuss the pathophysiology of small bowel obstruction (SBO), to discuss early recognition of this rare complication, and to recommend practice changes that may help prevent small bowel entrapment during USL procedures. This video presents a case of a small bowel strangulation resulting from bowel entrapment within a uterosacral ligament suspension suture. After reviewing the literature pertaining to the incidence of early small bowel obstruction in gynecology, we will discuss our patient's clinical presentation with a focus on her CT imaging and findings on diagnostic laparoscopy. Next, we use original illustrations throughout the video to illustrate the pathophysiology of small bowel obstruction, closed loop obstructions, and bowel strangulation. Finally, using original illustrations, we discuss practice changes which we have adopted to prevent this rare complication. Through this video we hope to teach clinicians about the presentation and Croton pathophysiology of closed loop small bowel obstruction, which are uncommon complications following uterosacral ligament colpopexy. We hope that this video will encourage clinicians to maintain a very high index of suspicion for this complication in patients who present with obstructive symptoms in the acute postoperative period following a uterosacral ligament colpopexy. In addition to suture removal, we emphasize that abdominal exploration with bowel examination is essential as a necrotic segment of bowel warrants urgent intervention with excision and anastomosis. Through this video we hope to teach clinicians about the presentation and pathophysiology of closed loop small bowel obstruction, which are uncommon complications following uterosacral ligament colpopexy. We hope that this video will encourage clinicians to maintain a very high index of suspicion for this complication in patients who present with obstructive symptoms in the acute postoperative period following a uterosacral ligament colpopexy. In addition to suture removal, we emphasize that abdominal exploration with bowel examination is essential as a necrotic segment of bowel warrants urgent intervention with excision and anastomosis.