Gastrointestinal complications in gynecologic surgery: a review for the general gynecologist.

A working familiarity with the management of common perioperative gastrointestinal complications is required for all general gynecologists. Thermal gastrointestinal injury requires resection of the damaged portion of bowel unless the injury involves only the bowel serosa and is less than 0.5 cm in diameter. Small intraoperative lacerations of the intestine can be closed primarily, whereas larger lacerations often require resection. Some degree of postoperative ileus may be expected, but prolonged ileus requires nasogastric suctioning while excluding bowel obstruction, peritonitis, or electrolyte imbalance. Small-bowel obstruction, most likely to be caused by postoperative adhesions, can often be treated successfully by gastrointestinal intubation. Steps required in the initial management of an enterocutaneous fistula include institution of parenteral nutritional supplementation and antibiotics, skin protection, and investigative studies of the fistula. Preventive measures may be used at the time of any surgical procedure to reduce the incidence of many of these complications.