title: Ischemic necrosis of small bowel following laparoscopic surgery.
abstract: OBJECTIVE
  Small bowel ischemia following laparoscopy was described recently as a rare fatal complication of the CO2 pneumoperitoneum. Of the 8 cases reported in the surgical literature, 7 were fatal, 1 was not. In this report, we describe the first gynecological case.
  
  
  METHODS
  A 34-year-old woman who underwent laparoscopy with extensive adhesiolysis and myolysis was re-admitted with an acute abdomen on postoperative day 4. Immediate laparotomy revealed acute peritonitis, extensive adhesions, and a 3-cm defect in the small bowel. Tissue examination showed ischemic necrosis of edematous, but essentially normal, bowel mucosa. The postoperative course was extremely complicated. She was discharged after a 2-month hospital stay in the intensive care unit for rehabilitation.
  
  
  RESULTS
  Data are available on 7 patients (including ours). All procedures were described as uneventful. The intraabdominal pressure was set at 15 mm Hg when specified. Some abdominal pain occurred in all, nausea and vomiting in 4, diarrhea in 2, abdominal distention in 1, fever in none. Quick reintervention laparotomy was performed in 2 and delayed in 5 (up to 4 days).
  
  
  CONCLUSIONS
  The CO2 pneumoperitoneum is a predisposing factor for intestinal ischemia as it reduces cardiac output and splanchnic blood flow. However, critical ischemia relies on underlying vasculopathy or an inciting event.
  
  
  CONCLUSIONS
  Patient selection, maintaining intraabdominal pressure at 15 mm Hg or less, and intermittent decompression of the gas represent the best options for preventing this complication.
authors.affiliation: University of Chicago, Chicago, Illinois, USA. drhasson@aol.com
authors.forename: Harrith M
authors.initials: HM
authors.lastname: Hasson
authors.forename: Christos
authors.initials: C
authors.lastname: Galanopoulos
authors.forename: Alexander
authors.initials: A
authors.lastname: Langerman
mesh_terms: D000328:Adult; D002245:Carbon Dioxide / Q000009:adverse effects; D005260:Female; D005740:Gases / Q000009:adverse effects; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology; D007421:Intestine, Small / Q000098:blood supply*; D007511:Ischemia / Q000209:etiology*; D010535:Laparoscopy / Q000009:adverse effects*; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects*; D000267:Tissue Adhesions / Q000150:complications* / Q000601:surgery
chemical_list: D005740:Gases; D002245:Carbon Dioxide