Partial small bowel obstruction and ileus following gynecologic laparoscopy.
OBJECTIVE
To assess the incidence and management of partial small bowel obstruction (PSBO) and ileus after gynecologic endoscopy.


METHODS
Internet-based cross-sectional survey (Canadian Task Force classification II-3).


METHODS
An online survey was distributed to gynecologic surgeons to collect information about frequency and management of ileus and PSBO after gynecologic laparoscopy.


RESULTS
Of the 58 physician respondents, 22 had managed at least 1 patient with PSBO or ileus after gynecologic laparoscopy. A total of 12 PSBOs and 14 patients experiencing ileus were identified for an overall incidence of 0.036%. Patients showed symptoms between 1 and 20 days postoperatively and had findings ranging from hypoactive (45%), to normal (30%), to hyperactive (25%) bowel sounds. Plain film radiographs (75%) were the most commonly used diagnostic modality followed by computed tomography (CT) scans of the abdomen. Most patients were initially managed with intestinal rest and nasogastric tube placement for 2 to 16 days. Fifty percent required a second procedure, with reported findings that included intestinal herniation (n = 7), bowel injury (n = 4), volvulus (n = 2), and urinoma (n = 1).


CONCLUSIONS
Ileus and PSBO are rare findings after gynecologic laparoscopy. We identified 26 cases, most of which were initially managed conservatively. The majority of patients ultimately required a second operation. Surgeons should have a high index of suspicion when managing a patient with PSBO or ileus after gynecologic laparoscopy. Given the findings from the second procedures, CT scans would seem to be the diagnostic procedure of choice.
Milad
Magdy P
MP
Department of Obstetrics and Gynecology, Northwestern University's Feinberg School of Medicine, Chicago, Illinois 60611, USA. mmilad@nmh.org
Escobar
Julian C
JC
Sanders
William
W
D000328:Adult; D000368:Aged; D003625:Data Collection; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D045823:Ileus / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D045822:Intestinal Volvulus / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D007421:Intestine, Small / Q000293:injuries; D010535:Laparoscopy / Q000009:adverse effects*; D019300:Medical Errors; D008875:Middle Aged; D011364:Professional Practice; D012086:Reoperation; D000267:Tissue Adhesions / Q000150:complications*; D014481:United States / Q000453:epidemiology