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Management of intra-abdominal, pelvic, and genitourinary complications of colorectal surgery

Robin Boushey, MD
Lara J Williams, MD, MSc, FRCSC
Section Editor
Martin Weiser, MD
Deputy Editor
Wenliang Chen, MD, PhD


The safety of colorectal surgery, as performed in patients with colorectal cancer and inflammatory bowel disease, has improved dramatically over the last 50 years due to improvements in preoperative preparation, antibiotic prophylaxis, surgical technique, and postoperative management. (See "Overview of the management of primary colon cancer" and "Rectal cancer: Surgical techniques" and "Surgical management of ulcerative colitis".)

Despite these advances, complications continue to occur. The risks, management, and outcomes of non-anastomotic intra-abdominal, pelvic, and genitourinary complications of colorectal surgery will be reviewed here. The management of anastomotic complications is reviewed elsewhere. (See "Management of anastomotic complications of colorectal surgery".)


Intra-abdominal complications during colorectal surgery include injury to adjacent organs, bleeding, and infection [1]. The incidence, risks, management, and outcomes of intra-abdominal injuries and complications are described here.

Splenic injury — The operative risk of splenic injury ranges from 0.4 to 8 percent of colonic procedures [2-4]. Injury occurs because of the close proximity of the colon to the spleen [2]. During mobilization of the splenic flexure of the colon, excessive traction on the peritoneal attachments and omentum can lead to avulsion of a portion of the splenic capsule [5]. In a review of 93,633 colorectal resections from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, splenic flexure mobilization increased the risk of an incidental splenic procedure (odds ratio [OR] 3.59, 95% CI 2.15-4.31) [6]. The risk of incidental splenic procedures was significantly greater for open compared with laparoscopic colorectal resection (OR 6.58, 95% CI 3.59-13.5). Other factors that increase the risk for iatrogenic splenic injury include previous abdominal surgery, midline incision, obesity, and advanced age [6,7].

Management of an intraoperative splenic injury includes splenic salvage (primary repair, splenorrhaphy) or splenectomy. Splenic salvage should be the first maneuver to control bleeding and a splenectomy reserved for cases when bleeding cannot be controlled by the previously described techniques. However, in a retrospective review of 975,825 patients undergoing a colorectal resection between 2006 and 2008, a splenectomy was performed for approximately 85 percent of patients (7963 of 9367) with a splenic injury rather than using a conservative splenic salvage procedure [4]. In a single institution review of 13,897 colectomies with 59 splenic injuries, the most common methods of initially managing splenic injuries included hemostatic agents (31 patients), packing (12), electrocautery (8), and suture ligatures (7) [2]. Multiple attempts at splenic salvage occurred in 30 patients, and 21 patients (36 percent of total splenic injuries) required a splenectomy. The 30-day major morbidity and mortality rates were 34 and 17 percent, respectively, with sepsis being the most frequent complication [2]. The initial and final management of the splenic injury was not associated with short-term adverse outcomes. (See "Surgical management of splenic injury in the adult trauma patient", section on 'Splenectomy versus salvage'.)

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Literature review current through: Dec 2017. | This topic last updated: Apr 01, 2017.
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