Bowel and Bladder injuries at Hysterectomy
Bowel injuries at the time of hysterectomy may occur when there are difficult adhesions like in the case of grade IV endometriosis or post operative adhesions following previous surgery. If the bowel is densely adherent to the uterus, it may be better to cut into the uterus using a scissor near the point of adhesion, rather than cutting at the junction of the bowel and the uterus. If the ileum or jejunum has been injured, the site should be first dissected from surrounding structures to make closure possible. In case the bladder has been entered and closed, it is not only the expertise in closing the injury that is important, but the bladder drainage post-operatively is equally important. While a continuous urinary catheter is kept in situ for 7-10 days, one should take care to put in a catheter with a very big opening, so that any flakes that may form are also drained.
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