Intestinal injury in gynecologic surgery: a ten-year experience.

From 1973 to 1982, a total of 128 incidents of intestinal injury were recorded in patients undergoing gynecologic operations. Of all lacerations, 37% occurred during entrance into the peritoneal cavity, 35% during lysis of adhesions or performance of pelvic or abdominal dissections, 10% during laparoscopy, 9% during vaginal operations, and 9% during dilatation and curettage and dilatation and evacuation. Injury involved the small intestines in 75% and the large intestines in 25% of the cases. Sixty-nine percent of all lacerations were minor, and 31% were major. Seventy-two percent of the lacerations occurred during uncomplicated gynecologic operations. All lacerations were repaired with one or more of four basic procedures: one- or two-layer closure of intestinal lacerations, partial bowel resection, intestinal reanastomosis, and colostomy. It is suggested that gynecologists acquire basic knowledge in the prevention of intestinal injury and the principles of repair of intestinal lacerations. The role of animal surgical laboratories for the training of residents practicing gynecologic surgery is emphasized.