- Gastrointestinal injury at the time of cesarean section is rare, approximately 1/1000 cesarean deliveries.
- Most injuries are minor lacerations amenable to primary repair at the time of laparotomy
- Generally occur at the time of abdominal entry or lysis of adhesions.
- Intraoperative diagnosis is critical.
- Thermal injury to the bowel or mesenteric injury (compromise of vascular supply) may require bowel resection.
Management of GI injury
- Instead of grasping bowel with instrument (causing crush injury), hold/support tissue with your hand while placing sutures
- 3.0 polyglycolic suture on a tapered needle
- For serosal injuries:
- Close with one layer, interrupted or continuous suture
- For full thickness lacerations:
- Close with two layers, umbricating the muscularis layer with the second layer
- Be sure to align the closure so it is perpendicular to the long axis of the bowel lumen, to prevent constriction rings
