Gastrointestinal injury

  • Gastrointestinal injury at the time of cesarean section is rare, approximately 1/1000 cesarean deliveries. 
  • Most injuries are minor lacerations amenable to primary repair at the time of laparotomy
  • Generally occur at the time of abdominal entry or lysis of adhesions. 
  • Intraoperative diagnosis is critical.
  • Thermal injury to the bowel or mesenteric injury (compromise of vascular supply) may require bowel resection. 

Management of GI injury

  • Instead of grasping bowel with instrument (causing crush injury), hold/support tissue with your hand while placing sutures
  • 3.0 polyglycolic suture on a tapered needle
  • For serosal injuries:
    • Close with one layer, interrupted or continuous suture
  • For full thickness lacerations:
    • Close with two layers, umbricating the muscularis layer with the second layer
  • Be sure to align the closure so it is perpendicular to the long axis of the bowel lumen, to prevent constriction rings
[Ref: Staley A, Rossi E. Approaching intraoperative bowel injury. ObGynNews. MDedge, October 2, 2017.]
[Image by M. Burnett, module author]
Updated on November 3, 2021

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