by Brian Camazine, M.D.

Laparoscopic bowel injury is a rare but potentially fatal complication. The incidence in the literature is approximately 1.3/1000. More than half these injuries are a result of electrocautery. In one study, 69% of the injuries were unrecognized at surgery. Of the injuries, 58% of the injuries were of the small bowel and 32% were of the colon (1). 

The delay in diagnosis of bowel injuries secondary to electrocautery “...is directly attributable to the nature of the lesion. The injury is caused by cautery, and diathermy-induced coagulative necrosis tends to manifest later (2). Patients with laparoscopic bowel injuries often have an unusual degree of postoperative abdominal pain (1,3). Abdominal distention with nausea and vomitting is also common. Sepsis usually occurs within 96 hours of surgery (1,4). 

Laparoscopic bowel injury is not necessarily a complication of inexperienced surgeons. Studies show that greater than 50% of these injuries occur at the hands of experienced surgeons (2,4) “Experienced surgeons often attempt to operate under less than ideal circumstances and in difficult situations with an unjustifiably high threshold of conversion to laparotomy. Consequently, the risk of bowel injury at their hands is more or less the same as that for more careful surgeons who are still in the beginning stages of their learning curve (2). 

Laparoscopic bowel injury can be easy to diagnose if a chest xray or CT is performed Many studies have specifically examined the xray findings of laparoscopic bowel injury. (3,5). These studies conclude that “Nonpathologic subdiaphragmatic free air may normally be present following laparoscopic cholecystectomy but it is uncommon 24 hours after the operation. When present, only a small volume is usually detectable.  For patients who develop abdominal pain greater than expected after laparoscopic procedures, the findings of subdiaphragmatic free air on a chest radiograph, particularly if it is of moderate volume or larger, should be considered diagnostic of a gastrointestinal perforation until proven otherwise” (3). 

REFERENCES                         

1. Laparoscopic bowel injury: incidence and clinical presentation. Bishoff JT, Allaf ME, Kirkels W, Moore RG, Kavoussi LR, Schroder F. J Urol. 1999 Mar;161(3):887-90.

2. Management of laparoscopic-related bowel injuries. El-Banna M, Abdel-Atty M, El-Meteini M, Aly S. Surg Endosc. 2000 Sep;14(9):779-82.

3. Incidence and significance of subdiaphragmatic air following laparoscopic cholecystectomy.  Schauer PR, Page CP, Ghiatas AA, Miller JE, Schwesinger WH, Sirinek KR. Am Surg. 1997 Feb;63(2):132-6.  

4. Mechanism, management, and prevention of laparoscopic bowel injuries. Schrenk P, Woisetschlager R, Rieger R, Wayand W. Gastrointest Endosc. 1996 Jun;43(6):572-4.  

5. CT findings after uncomplicated and complicated laparoscopic cholecystectomy. McAllister JD, D'Altorio RA, Rao V. Semin Ultrasound CT MR. 1993 Oct;14(5):356-67.

BIOGRAPHY

Brian Camazine, M.D. is a General and Thoracic Surgeon at the Central Texas Veterans Health Care Center in Temple, Texas. He did Medical School training at Harvard University, General Surgery training at the University of Arizona, Tucson, and Thoracic Oncology Fellowship training at Roswell Park Cancer Institute.

Dr. Camazine is interested in surgical oncology, especially lung, esophageal, and head and neck cancer. His main avocation is practicing surgery in third world countries. He has operated in Nigeria, Bolivia and Guatemala. 

In addition to surgery, Dr. Camazine is interested in medicolegal consulting. He works with attorneys for both plaintiffs and defendants. He is meticulous in his research and strives to maintain high quality in surgery.  

Dr. Camazine lives with his wife Susan, and three beautiful children, Maraya, Deryk and Kaiden. 

ABOUT Brian Camazine, M.D.