eP745 - Laparoscopic Repair of Rectal Perforation After Hysteroscopy

Purpose/Background: To describe the laparoscopic repair of post operative rectum perforation in a patient with septic shock. Iatrogenic bowel perforation following gynecologic procedures has been described. It can involve various parts of the digestive tract including large bowel or small bowel.Methods/Interventions: A 54-year-old woman underwent diagnostic hysteroscopy for post-menopausal vaginal bleeding. Curettage and cauterization were performed during the procedure. 24 hours following the hysteroscopy, the patient developed severe abdominal pain. Abdominal films were obtained and revealed free air under both diaphragms. Emergency diagnostic laparoscopy showed serosanguinous free fluid and uterine fundus full thickness perforation. Formal laparoscopy and including air leak test showed no bowel perforation. Patient developed acute abdomen after 24 hours. Second laparoscopy showed rectal perforation which repaired laparoscopically.Results/Outcomes: The patient was transferred to the intensive care unit where she was extubated soon after. She remained in ICU for 15 days for pulmonary rehabilitation, nutritional support, and physical therapy for severe deconditioning. On post operative day 12 she had fluid collection in the abdomen which was drained by interventional radiology. She was discharged on post-operative day 19 without any further complications.Conclusion/

Discussion: Gastrointestinal perforation are significant event with associated morbidity and mortality. Prompt recognition and repair are critical. Laparoscopic repair can be difficult due to significant abdominal distention from dilated small bowel. At the hands of expert surgeons, laparoscopic repair can be feasible with good outcome.