Fortunately, visceral injuries during cesarean section are rare. Prevention is key.
- Maintain a high index of suspicion in cases where pelvic adhesions are likely to be present (including if your patient has had previous surgery). Inspect the surface of the bowel or bladder at the site of lysed adhesions.
- Enter the peritoneal cavity more cephalad than usual, especially in the setting of a repeat cesarean section, where there may be scarring between the bladder and lower uterine segment. Visualize bladder with transillumination.
- Use sharp dissection for a bladder flap. This can help to safely enter the uterus.
- Close bladder dome lacerations in two layers with absorbable suture.
- Close intestinal lacerations perpendicular to the long axis of the bowel.
- Remember: Almost all injuries are easily manageable with your skill set!