Bhullar Jasneet Singh, Gayagoy Jennifer, Chaudhary Sushant, Kolachalam Ramachandra B
Department of Surgery, Providence Hospital & Medical Centers, 16001 W 9 Mile Rd, Southfield, MI 48075, USA.
JSLS. 2013 Jul-Sep;17(3):495-8. doi: 10.4293/108680813x13753907292070.
Bowel injury during laparoscopic surgery is a rare but serious complication. A Bovie injury to the bowel can cause delayed perforation of the viscus, thus increasing the possibility of a preventable morbidity. Patients presenting with perforation peritonitis within 24 hours and up to 2 to 3 weeks after laparoscopic Bovie injury to the bowel have been reported in the literature.
A 74-year-old woman underwent a laparoscopic ventral hernia mesh repair. Intraoperatively, a small area of superficial Bovie injury to the small bowel was repaired with Lembert sutures and tissue glue. Postoperatively, the patient recovered well, but she presented with perforation peritonitis 3 months after surgery. An exploratory laparotomy showed a jejunal perforation in the same area that was injured with cautery and repaired during the previous surgery. The patient was only using inhaled steroids for asthma on and off but had a remote history of chemotherapy and radiation for colorectal cancer.
Bovie injury to the bowel has a hidden depth, causing a slow transmural tissue necrosis, and it might also impair local healing and eventually lead to perforation. Thus, the patient may present later than the usual period for wound healing and remodeling as previously reported. Given the disastrous consequence, it is imperative to perform a good surgical repair of even a minor Bovie injury to the bowel. This is the first report of a delayed presentation (>1 month) of a Bovie injury of the bowel.
腹腔镜手术期间的肠损伤是一种罕见但严重的并发症。电刀对肠道的损伤可导致内脏延迟穿孔，从而增加可预防的发病率。文献报道了在腹腔镜电刀损伤肠道后24小时内以及长达2至3周出现穿孔性腹膜炎的患者。
一名74岁女性接受了腹腔镜腹疝补片修补术。术中，用伦伯特缝合法和组织胶水修复了小肠表面小面积的电刀损伤。术后，患者恢复良好，但在术后3个月出现了穿孔性腹膜炎。剖腹探查显示，在先前手术中受电灼损伤并修复的同一区域出现空肠穿孔。该患者仅偶尔使用吸入性类固醇治疗哮喘，但有直肠癌化疗和放疗史。
电刀对肠道的损伤有隐匿深度，会导致缓慢的透壁组织坏死，还可能损害局部愈合并最终导致穿孔。因此，患者可能比先前报道的伤口愈合和重塑的正常时间出现得更晚。鉴于后果严重，即使是轻微的电刀对肠道的损伤，也必须进行良好的手术修复。这是第一例肠电刀损伤延迟出现（>1个月）的报告。
