Occlusion of the Small Intestine After Operative Laparoscopy

A woman with diagnosis of missed abortion had complications of uterine perforation during dilatation and curettage (D&C). Under laparoscopic guidance the uterus was emptied of the remains of fetal tissue. An opening on the uterus was sutured laparoscopically. There was a superficial tear on the mesosigmoid. The sigmoid colon and the bladder were checked and were intact. Fourteen days after the operation the woman returned complaining of nausea, vomiting, and lower abdominal pain. The diagnosis was obstruction of small intestine. At laparotomy we found a loop of small intestine adhering to the ileum. This was untwisted and the patient was discharged in good condition. The cause of this complication might be trauma to small intestine during D&C that was not diagnosed by laparoscopy, or entry of infected tissue into the peritoneal cavity during D&C. Since the many loops of small intestine make it difficult to check at laparoscopy, it is suggested laparotomy be performed if the surgeon suspects trauma in the intestine.