Successful detection of rectal injury during laparoscopic surgery using a rectal probe in a patient with deep endometriosis

Abstract

Laparoscopic surgery has become the gold standard treatment for endometriosis. Surgical treatment of deep endometriosis with colorectal involvement is challenging. It requires complete surgical excision of lesions despite a high risk of complications that include rectal injury, rectovaginal fistula and pelvic abscess. An intraoperative air leak test allows detection of rectal injury and reduces postoperative complications. We report a case of successful management of rectal injury during laparoscopic surgery using a rectal probe even though air leak tests were negative. A 45‐year‐old woman with severe endometriosis and rectal involvement underwent total laparoscopic hysterectomy combined with rectal shaving. A pinhole injury that reached the rectal muscularis layer without breaching the mucosal layer was identified using a rectal probe after negative air leak tests. The injury was repaired uneventfully. Our experience suggests that using a rectal probe could be helpful for early detection and safe repair of rectal injury during surgery.

Identifying Risk Factors for Complications in Gynecologic Laparoscopic Surgery: A Retrospective Study

“…Among these injuries, the small intestine is the most commonly affected site (55.8%), followed by the large intestine (38.6%) and the stomach (3.9%) [20]. A study involving 12,354 patients undergoing laparoscopic surgery reported 15 cases of rectal injury [21]. In our study, one patient who had undergone two previous surgeries required transvaginal repair of a rectovaginal fistula, resulting in a yellow-green vaginal discharge.…”

Retrograde hysterectomy approach in a patient with a frozen pelvis due to a suspected ovarian malignancy

“…Surgical treatment of gynecological disease with colorectal involvement is a challenge which requires complete surgical excision of lesions. 1 Blind blunt dissection of the Douglas pouch might cause massive and rectal tissue damage. 2 3 Traditional hysterectomy may cause rectal injury for those cases with severe adhesion in the Douglas pouch.…”