title: Bowel perforation caused by an endoscopic stapler used during laparoscopically assisted vaginal hysterectomy. A case report.
abstract: BACKGROUND
  A commonly cited concern regarding laparoscopic hysterectomy is that the risks and complications associated with the procedure may be greater than those associated with more-traditional hysterectomy techniques. Among the potential risks that are unique to this approach are injuries caused by laparoscopic instrumentation. The events described below constitute the first known case of a postoperative bowel perforation caused indirectly by an automatic stapler used during a laparoscopically assisted vaginal hysterectomy (LAVH).
  
  
  METHODS
  A 52-year-old, African American woman underwent an uncomplicated LAVH, bilateral salpingo-oophorectomy and anterior repair in January 1995. Approximately nine months later, the patient began experiencing abdominal pain during a trip to Europe. Her condition progressively deteriorated to the point that an emergency landing in Iceland was required during her flight home. The patient was found to have a bowel obstruction and underwent a laparotomy and bowel resection. An open staple from the endoscopic stapler that was used at the time of LAVH was found to have caused the bowel perforation, which eventually resulted in adhesion formation and obstruction.
  
  
  CONCLUSIONS
  Every effort should be made to remove loose staples from the operative field prior to termination of a laparoscopic procedure.
authors.affiliation: Department of Obstetrics and Gynecology, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Abularach
authors.forename: S
authors.initials: S
authors.lastname: Ashai
mesh_terms: D005260:Female; D005547:Foreign Bodies; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects*; D007077:Ileal Diseases / Q000209:etiology*; D007416:Intestinal Perforation / Q000209:etiology*; D010535:Laparoscopy / Q000009:adverse effects*; D008875:Middle Aged; D013528:Surgical Staplers / Q000009:adverse effects*