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  • Title: Thermal injury to the bowel as a complication of laparoscopic sterilization.
    Author: Maudsley RF, Qizilbash AH.
    Journal: Can J Surg; 1979 May; 22(3):232-4. PubMed ID: 155495.
    Abstract:
    Thermal injury to the small bowel occurred four times in a series of 7466 consecutive laparoscopies and tubal cauterization performed for sterilization. The four patients presented with signs and symptoms of delayed bowel perforation 4 to 11 days after the procedure. The perforations were small and involved the antimesenteric border of the terminal ileum. Histologic study of the excised specimen in one case showed full thickness coagulative necrosis of the bowel wall. Potential causes for bowel burn associated with tubal cauterization are discussed. Steps to minimize the occurrence of this complication include proper use of the laparoscope and cautery equipment, good anesthesia and gas distension of the abdomen, correct positioning of the patient and clear visualization of the operative field. Charts of all patients who underwent laparoscopic sterilization at the Henderson General Hospital in Hamilton, Ontario, Canada between February 1, 1970 and December 31, 1971 were reviewed. Intestinal burns were found to have occurred in 3 of these 1430 patients. An additional 6036 laparoscopic sterilizations were performed between January 1, 1972 and December 31, 1977. Among the latter group a 4th instance of a bowel burn occurred and only in this last case was a detailed histologic examination of the excised intestinal tissue performed. The technique of laparoscopic sterilization used at this hospital is tubal cauterization without subsequent division of the fallopian tube. The 4 patients presented with signs and symptoms of delayed bowel perforation 4-11 days following the procedure. The perforations were small and involved the antimesenteric border of the terminal ileum. The histologic study of the excised specimen in 1 case showed full thickness coagulative necrosis of the bowel wall. Thermal injury to the bowel may occur in 1 of several ways: 1) inadvertent touching or grasping of the bowel during the application of current; 2) a portion of bowel, unnoticed, may come into contact with the laparoscope trocar sleeve; 3) sparking from the coagulation forceps to the bowel; and 4) current passing along the fallopian tube and jumping from the fimbriated end to the bowel. Steps to minimize the occurrence of this complication include proper use of the laparoscope and cautery equipment, good anesthesia and gas distension of the abdomen, correct positioning of the patient and clear visualization of the operative field.
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