Magdy P Milad1, Julian C Escobar, William Sanders. 1. Department of Obstetrics and Gynecology, Northwestern University's Feinberg School of Medicine, Chicago, Illinois 60611, USA. mmilad@nmh.org
Abstract
STUDY OBJECTIVE: To assess the incidence and management of partial small bowel obstruction (PSBO) and ileus after gynecologic endoscopy. DESIGN: Internet-based cross-sectional survey (Canadian Task Force classification II-3). MATERIAL AND METHODS: An online survey was distributed to gynecologic surgeons to collect information about frequency and management of ileus and PSBO after gynecologic laparoscopy. MEASUREMENTS AND MAIN 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). CONCLUSION: 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.
STUDY OBJECTIVE: To assess the incidence and management of partial small bowel obstruction (PSBO) and ileus after gynecologic endoscopy. DESIGN: Internet-based cross-sectional survey (Canadian Task Force classification II-3). MATERIAL AND METHODS: An online survey was distributed to gynecologic surgeons to collect information about frequency and management of ileus and PSBO after gynecologic laparoscopy. MEASUREMENTS AND MAIN 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). CONCLUSION: 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.
Authors: Johnna Schölin; Mark Buunen; Wim Hop; Jaap Bonjer; Bo Anderberg; Miguel Cuesta; Salvadora Delgado; Ainitze Ibarzabal; Marie-Louise Ivarsson; Martin Janson; Antonio Lacy; Johan Lange; Lars Påhlman; Stefan Skullman; Eva Haglind Journal: Surg Endosc Date: 2011-06-11 Impact factor: 4.584