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 "Overview of surgical procedures for resectable primary rectal cancer" and "Surgical management of ulcerative colitis".)
Despite these advances, complications continue to occur. The risks, management, and outcomes of non-anastomotic intraabdominal, 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 INJURIES AND COMPLICATIONS
Intra-abdominal complications during colorectal surgery include injury to adjacent organs, bleeding, and infection . 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 . During mobilization of the splenic flexure of the colon, traction on the peritoneal attachments and omentum leads to avulsion of a portion of the splenic capsule. Additional technical and clinical conditions that increase the risk for iatrogenic splenic injury include previous abdominal surgery, midline incision, obesity, and advanced age .
Management of an intraoperative splenic injury includes splenic salvage (primary repair, splenorrhaphy) or splenectomy. 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) . 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 . The initial and final management of the splenic injury was not associated with short-term adverse outcomes.