Small bowel obstruction from barbed suture following laparoscopic myomectomy-A case report

Abstract

Myomectomy is commonly performed for symptomatic fibroids in women who wish to conserve fertility. Laparoscopic myomectomy provides advantages as a minimally invasive procedure. To facilitate the closure of the uterine wound after enucleation of the fibroid, barbed sutures have been introduced as they can shorten the operative time and reduce the amount of bleeding. However, the use of barbed suture is not without risk. There were a few reports on the risks of barbed sutures in the literature. We report herein a case of acute abdomen because of small bowel entrapment and obstruction following the use of barbed suture in laparoscopic myomectomy. Surgeons using barbed suture in myomectomy should be vigilant on the possibility of this bowel complication whenever adverse clinical situation arises as the outcome could be serious if the condition was left unchecked.

Keywords: Barbed suture; Laparoscopy; Myomectomy; Obstruction; Small bowel.

Fig. 1

(a) showed dilated small bowels; (b) adhesion band between small bowel and uterus; (c) adhesions between large bowel and uterus; (d) barbed suture arising from uterus exposed after adhesiolysis.

Fig. 2

(a) barbed suture wrapped in mesentery; (b) showed adhesion band and obstructed area on the small bowel; (c) barbed suture exposed from the uterus; (d) erosion on small bowel.