Postoperative peritonitis caused by thermal injury during laparoscopic colectomy: lesson learned

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Postoperative peritonitis caused by thermal injury during laparoscopic colectomy: lesson learned

Authors

J Leroy, A Rikkers, J Marescaux

Media type

Surgical video

Duration

04'00''

Publication

2005-08

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E-publication

WeBSurg.com, Aug 2005;5(08).
URL: http://www.websurg.com/doi-vd01en1722.htm

Postoperative peritonitis caused by thermal injury during laparoscopic colectomy: lesson learned

1. Case presentation 00'10''

This is the case presentation of 45-year-old female who presents for elective resection of a recurrent sigmoid diverticular disease. This CAT-scan image is indicative of a previous bout with diverticulitis. This barium enema notes the sigmoid diverticula preoperatively in a likely need for mobilization of the splenic flexure for a tension-free anastomosis. The patient underwent a laparoscopic sigmoidectomy uneventfully. However, 48 hours postoperatively the patient’s condition depreciates and the abdomen is tense.

2. Exploration and detection of colon injury 00'46''

A laparoscopy is performed and diffuse peritonitis is noted. We review the anastomotic site first. Common etiology of peritonitis in the post-colectomy patient is anastomotic dehiscence. Fistulas and bowel injury follow in frequency. Upon inspection, a 1cm defect is noted in the colon at the area we dissected.

3. Suture of colon injury 01'16''

We utilize 2/0 absorbable suture to close this defect in an interrupted stitch fashion.

4. Transverse colostomy 01'38''

After washout of the abdominal cavity with copious amounts of saline, we begin the planning stages of a transverse loop colostomy. The transverse colon is identified and brought up through a previous port site that was used in the original sigmoidectomy.

5. History of injury 02'08''

During our elective sigmoidectomy 48 hours earlier, we noted the Ligasure device was adjacent to the colon. Here you see that the Ligasure device was immediately adjacent to the serosa of the colon. We reviewed this site at the end of the procedure as well and noted no change. We did not believe an injury occurred. Minimally invasive surgery has shown the decreased postoperative morbidity in the colectomy patient. When this scenario was not present in the postoperative patient immediate action needs to take place. Thermal injury created by the Ligasure device to collateral tissues is minimal but present. The surgeon must be aware of this and be able to treat resulting injuries appropriately and properly.