Intestinal Ischemia After Laparoscopic Cholecystectomy

OBJECTIVES Intestinal ischemia is a rarely reported complication following laparoscopic cholecystectomy. We describe a case of massive small intestinal necrosis 3 days following this procedure. An autopsy determined the cause to be splanchnic hypoperfusion, likely due to the physiologic changes induced by the pneumoperitoneum necessary to conduct the surgery. We sought to determine whether all reported cases of intestinal ischemia following laparoscopic cholecystectomy (LC) shared the same etiology, and if faulty operative technique could be invoked. METHODS A review of all known published cases of intestinal ischemia following LC was conducted to determine the underlying etiology of ischemia, and whether adequate operative technique had been observed. RESULTS Multiple causes of intestinal ischemia following LC have been described: splanchnic hypoperfusion, thrombosis of the superior mesenteric artery, and thrombosis of the inferior mesenteric vein. All occurred despite correct operative technique. CONCLUSIONS Intestinal ischemia following LC has diverse causes. Patient factors rather than faulty operative technique would appear to underlie the development of this rare complication.