Bowel Injuries after Laparoscopic Ovarian Drilling: Observation of Three Cases with Review of Literatures

Background : Bowel injury remains a potential serious complication of gynecological laparoscopy. Electro thermal energy, especially in the form of monopolar diathermy, is used widely during Laparoscopic Ovarian Drilling (LOD) by diathermy for clomiphene-resistant polycystic ovary disease (PCOD). Occasionally there can be unrecognized transfer of energy in the operating area, resulting in electro thermal bowel injury. If iatrogenic bowel injury is not recognized at the time it occurs, it can have devastating consequences. Objectives : Through personal observations of 3 patients who underwent (LOD) for clomiphene-resistant (PCOD) followed by bowel perforation ,we highlighted their ways of presentation , recognition , avoidance and management of such complication. Setting : Surgical wards of Al-Jamhoori Teaching Hospital in Mosul City Patients and Methods : Through personal observation, we report a series of 3 infertile women who underwent laparoscopic ovarian drilling for clomiphene resistant infertility but were readmitted 2-3 days later with pinhole leaks from perforated bowel . Results : After (LOD ) ,two patients out of three were urgently explored via laparotomy and multiple bowel perforations were found and repaired. Consequently they improved .The third patient presented lately after rupture of bowel and peritonitis. Although she underwent explorative laparotomy but her condition was potentially fatal and died from sepsis. avoid complications with consultation and involvement of surgeons early following the procedure. High clinical suspicion is crucial for early diagnosis of bowel injuries. When diagnosis is delayed, then morbidity and mortality rises.