Afzal M, Nargis Iqbal.
Bowel injuries during gynaecological surgery - Still a challenge.
Pak J Surg Nov ;31(4):252-5.

Introduction: Iatrogenic injury to gastrointestinal tract is not uncommon in patients with pre existing risk factors. Good knowledge of basic principles of management is mandatory for patient safety. Objectives: To determine the frequency of bowel injury during gynaecological surgery. Patients and methods: Twenty six patients with bowel injury during gynaecological surgery were included in the study. A retrospective descriptive study was carried out from January 2012 to December 2013. Age, parity, previous obstetrical and gynaecological history, primary pathology, site of injury and other variables were analyzed. Results: Majority of patients (73%) were operated for elective laparotomy for ovarian cancer or hysterectomy for uterine pathology. Small gut injury in 76.92% of patients and large intestine damage in 23.07% was recorded. A signifi cant number (26.92%) was suff erer of unsafe abortion att empts. Primary closure and resection of injured gut was the procedure of choice in small gut and right colon damage in haemodynamically stable patients. In deteriorating patients with small gut injury or left sided large gut injury in unprepared bowel, enterostomy was chosen to save time and minimize operative trauma. Conclusion: Untoward intestinal injury is sometimes unavoidable in pelvic pathology especially when invasive nature of the disease or adhesiolysis is encountered during surgery. A pelvic surgeon must be aware of and be able to manage bowel complications to minimize the morbidity and mortality.

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