Bowel Injury During Laparoscopy: Intraoperative Presentation

This chapter presents a case of a woman who underwent laparoscopy for assessment of chronic pelvic pain. She had previously undergone two laparoscopies for treatment of endometriosis, and a vertical midline laparotomy for myomectomy. Although seemingly certain of the abdominal wall layers under direct vision, the surgeon recognized the view of the bowel lumen. Many times traumatic bowel injuries occur during the insertion of Veress needle, trocar, or a secondary port. Bowel injuries can be repaired through a laparotomy or by laparoscopic surgery. It is generally accepted that bowel injury may be more readily recognized with methods of entry under visual control such as open entry or the use of optical trocar as illustrated in this case. Choosing alternative primary port placement sites away from the umbilicus, such as the left upper quadrant, may reduce the chance of encountering bowel injury from midline adhesions in high-risk cases.