A case of rectal injury due to vaginal pipe misinsertion during total laparoscopic hysterectomy

Abstract

A case of rectal injury due to vaginal pipe misinsertion during total laparoscopic hysterectomy Yuki Yoshimura1,2 , Kentaro Nakayama1, *, Kiyoka Sawada1 , Hitomi Yamashita1 , Kohei Nakamura1 , Tomoka Ishibashi1 , Masako Ishikawa1 , Sultana Razia1 , Seiya Sato1 , Satoru Kyo1 1Department of Obstetrics and Gynecology, Shimane University, 685-0005 Shimane,Japan 2Department of Obstetrics and Gynecology, National Hospital Organization Hamada Medical Center, 685-0005 Shimane,Japan *Correspondence: kn88@med.shimane-u.ac.jp (Kentaro Nakayama) DOI:10.31083/j.ceog.2021.01.2170 This is an open access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/). Submitted: May 29, 2020 Revised: July 22, 2020 Accepted: July 28, 2020 Published: February 15, 2021 Total laparoscopic hysterectomy (TLH) is one of the techniques feasible for the treatment of myoma. Our department has performed more than 1,000 laparoscopic hysterectomies since 2014. In our department, these surgeries are performed by a supervising doctor, operator, and a first assistant who is oȻten insuȞficiently experienced. There are several types of injuries that can occur during laparoscopic surgery; however, cases in which the vaginal pipe is inserted incorrectly are very rare. Here, we report the case of a 47-year-old nulliparous woman who experienced a rectal injury caused by the misinsertion of a vaginal pipe into the rectum. Seven years prior, she had undergone a myomectomy for leiomyomas. Later, she developed recurrent leiomyomas and worsening hypermenorrhea; therefore, she underwent a total laparoscopic hysterectomy. During the operation, the first assistant usually inserts a vaginal pipe into the vagina when the vaginal wall is cut. In this case, when the vaginal wall was cut, the vaginal pipe was inserted into the rectum, and the rectal wall was incised, allowing communication between the rectum and vagina. The rectum was repaired with the support of a gastroenterological surgeon, and the operation was completed laparoscopically. On the 7th postoperative day, an enema was performed to confirm that no leaks were present, and feeding was restarted. The patient was discharged home on the 17th postoperative day. The current case highlights the necessity of surgeons to be aware of various factors when performing this procedure to prevent complications, even those that are rare. Keywords Uterine leiomyoma; Rectal injury; Total laparoscopic hysterectomy