Early postoperative small bowel obstruction after laparoscopic myomectomy

Objective: To describe an early small bowel obstruction after robotic-assisted laparoscopic myomectomy with the Davinci system. Design: Case report. Setting: Academic medical center. Patient(s): Two days after a robotic-assisted laparoscopic myomectomy, a 35-year-old nulligravid African-American woman developed a small bowel obstruction due to retained myoma fragments that had implanted on and subsequently kinked loops of the small bowel. Intervention(s): The patient was managed conservatively for 4 days with bowel rest and IV hydration. Due to worsening clinical symptoms and supportive radiologic findings, exploratory laparotomy was performed to lyse adhesions and remove the implanted myoma pieces. Main Outcome Measure(s): Clinical resolution of small bowel obstruction symptoms. Result(s): No bowel resection was needed for this patient. Conclusion(s): Prompt recognition and operative treatment of the small bowel obstruction prevented the need for intestinal resection. To reduce the risk of ectopic implantation of myoma fragments, meticulous care should be taken to remove all remnants of morcellated tissue. Immediate postoperative complications, such as bowel obstruction, and long-term complications related to recurrent myomas may then be avoided.