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Ginecología y obstetricia de México

Print version ISSN 0300-9041

Abstract

SAUCEDO-LOPEZ, Ángel; TOPETE-ESTRADA, Rafael; SAUCEDO-LOPEZ, Alfonso  and  GOMEZ-FERNANDEZ, Alejandra. Incidental splenic injury during laparoscopic gynecological surgery associated with the entry technique. A case report and literature review. Ginecol. obstet. Méx. [online]. 2020, vol.88, n.6, pp.412-419.  Epub Sep 30, 2021. ISSN 0300-9041.  https://doi.org/10.24245/gom.v88i6.3864.

BACKGROUND:

Incidental spleen injuries during gynecological laparoscopic surgery are rare complications that have a major impact on perioperative morbidity and mortality. Laparoscopic management through assisted compression and haemostatic products has been a recommended option in patients who have splenic lesions secondary to the path of laparoscopic trocars.

CLINICAL CASE:

48-year-old patient with anemic syndrome secondary to 6-month-old menstrual disorders. It is protocolized in the Department of Gynecology of the Hospital Dr. Manuel Gea González where it is classified P0A0L1M0 - C0O1E1I0N0 (FIGO 2011). It is proposed for laparoscopic hysterectomy with bilateral salpingophrectomia. In the surgical act there is active bleeding dependent on splenic wall. It is compressed from the bleeding site and Surgicel® (absorbable hemostatic product - Ethicon) is applied, presenting hemostasis. The patient evolved successfully and left without incident.

CONCLUSION:

There are few documented reports of incidental splenic injuries in laparoscopic gynecological surgery. The most dangerous part of laparoscopy is the introduction of the Veress needle and the trocar, where visceral lesions or blood vessels may occur. Timely diagnosis of these complications is important for proper treatment. Incidental splenic injuries should be treated by a multidisciplinary team.

Keywords : Incidental injury; Gynecological laparoscopic surgery, Laparoscopic complications, Trocar entry injuries, Spleen injury.

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