The Efficacy of Intraoperative Esophagogastroduodenoscopy in Localizing Retroperitoneal Bowel Injury: A Case Report

TL;DR

This case report discusses how intraoperative endoscopy can help detect hidden bowel injuries during surgery, especially in complex abdominal trauma.

Contribution

The paper highlights the potential of intraoperative EGD as a valuable tool for identifying retroperitoneal bowel injuries in a real-world clinical scenario.

Findings

Intraoperative EGD was useful in identifying a retroperitoneal bowel injury that was not immediately visible.

Collaboration between surgeons and gastroenterologists enhances the effectiveness of intraoperative endoscopy.

Abstract

The efficacy of intraoperative esophagogastroduodenoscopy (EGD) in visualizing a patient’s small bowel interior to detect injuries or lesions, or conduct a leak test post-bowel anastomosis, makes it a preferred option among surgeons. However, it is not always available, can carry a risk of morbidity and mortality, or can prolong operative time if not performed by a proficient team. A 21-year-old male patient came to the emergency department with four gunshot wounds to his abdomen, with two on either side of the abdomen. Exploratory laparotomy was performed and through and through injuries were identified in the small bowel and at the junction of the third/fourth portion of the duodenum. It was challenging to gather the patient’s past medical history, particularly gastrointestinal bleeding history, due to the underlying medical condition. However, the patient had experienced a retroperitoneal bowel injury in the setting of duodenal hematoma that was not immediately identified at first glance. In this context, intraoperative endoscopy could be a significant adjunct to detect retroperitoneal bowel injury if rapidly available and in a controlled scenario. Moreover, the advantages of intraoperative EGD increase with positive collaboration between a general surgeon and a gastroenterologist.

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