Delayed Presentation of a Bowel Bovie Injury After Laparoscopic Ventral Hernia Repair

Jasneet S Bhullar, MD, MS, Jennifer Gayagoy, MD, Sushant Chaudhary, MD, MS, Ramachandra B Kolachalam, MD

Department of Surgery, Providence Hospital and Medical Centers, Southfield, MI, USA

Abstract:
Bowel injury during laparoscopic surgery is a rare but a 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 2-3 weeks after laparoscopic bovie injury to the bowel have been reported in the literature.

Case Report:
A 74 year old female underwent a laparoscopic ventral hernia mesh repair. Intra operatively a small area of superficial bovie injury to small bowel was repaired with lembert sutures and tissue glue. Post operatively she recovered well, but presented with perforation peritonitis 3 months after her surgery. An exploratory laparotomy revealed a jejunal perforation at the same area which was injured with cautery and repaired during the prior surgery. The patient was only using inhaled steroid use for asthma on and off, but had a remote history of chemotherapy and radiation for colon cancer.

Conclusions:
Bovie injury to the bowel has a hidden depth, causing a slow transmural tissue necrosis and might also impair the local healing and eventually leading to perforation. Thus the patient may present later than the usual time period for wound healing and remodelling as previously reported. Given the disastrous consequence, it is imperative to do 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.


Session: Poster Presentation

Program Number: P595

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