Colic Perforation as a Complication of Tension-Free Vaginal Tape Procedure

Abstract

The tension-free vaginal tape (TVT) procedure was first described as a minimally invasive surgical technique for the treatment of female stress urinary incontinence. The most common complications associated with TVT are bladder perforations and postoperative voiding difficulties. We report a case of bowel perforation occurring during the insertion of TVT. CASE REPORT A 52-year-old nonobese woman with a history of appendectomy, open pelvic retroperitoneal ureterolithotomy and laparoscopic fallopian tube section presented with genuine stress urinary incontinence without pelvic prolapse. Urodynamic study demonstrated normal urethral closure pressure and no bladder instability. TVT placement was elected. The patient was placed under general anesthesia and the TVT procedure was performed. Perioperatively bladder perforation was observed on the left side, indicating a change in the position of the trocar. On postoperative day 1 the patient had acute general abdominal pain with fever. X-ray of the abdomen showed a pneumoperitoneum, which indicated urgent laparotomy exploration (fig. 1). At laparotomy we discovered general stercoral peritonitis, with the right tape penetrating the pelvic peritoneum and transfixing the cecum. The left tape was observed penetrating the right third segment of the transverse colon. We noted that the cecum and colon had a massive adhesion to the bladder, retropubic space and pelvic peritoneum. The tape was cut in its intraperitoneal portion and then totally removed through the vaginal incision of the TVT procedure. Right hemicolectomy with a terminal ileostomy was done. Postoperatively the patient recovered with antibiotic management and was discharged home on day 6 after laparotomy. Three months later intestinal continuity was successfully established. At followup visits the patient has had a recurrence of the stress incontinence without urge incontinence but she has refused further surgical repair. DISCUSSION