Uncommonly Reported Complications Following Gallbladder Surgery

According to an article published in the journal Surgical Endoscopy 8:197 (1994) entitled “Thermal Injury of the Posterior Duodenum During Laparoscopic Cholecystectomy”, although bile duct injuries are the most commonly reported complications of gallbladder surgery, bowel injuries are rarely reported. 

There are two types of bowel injures.  The first is a penetrating bowel injury, which can be caused by either a Verres needle or trocar.  Injuries caused by a trocar or Verres needle usually involve the stomach, small intestine, colon or blood vessels.  These injuries are commonly recognized and repaired. 

The second is a thermal bile injury, which can be the result of either a direct contact burn or conductive burn.  Bowel burn injuries usually occur during dissection of the cystic duct.  Contact burn injuries may be recognized and treated appropriately.  However, conductive burns are either not recognized at all or recognized 1 – 2 weeks following the initial procedure.  Therefore, these are difficult to diagnose due to their rarity and delayed presentation.

This article reports on the case of an apparent conductive burn injury to the posterior small intestine following laparoscopic gallbladder surgery.  The injury manifested itself six days after the laparoscopic gallbladder surgery.  The unrecognized injury resulted in necrosis to the wall of the small intestine.

The diagnosis and management of this unusual case were presented to increase awareness of the risks of gallbladder surgery.