Treatment of iatrogenic injuries should occur during the operation. Iatrogenic bowel perforations should be repaired by the surgeon primarily or with resection followed by anastomosis. Iatrogenic vascular injuries, most likely to the pelvic or abdominal veins, can be repaired primarily or with an end-to-end anastomosis. Repair of ureteral injuries can be optimized with the utilization of stents.
The rate of surgical site infections (SSIs) have been significant reduced with antibiotic prophylaxis. Most studies recommend IV doses of a second generation cephalosporine with or without metronidazole with the first dose administered prior to skin incision. SSIs can be treated with antibiotics and opening of the wound to allow drainage if necessary.
Contained anastomotic leaks in stable patients can be treated with CT-guided percutaneous drainage. Unstable patients or patients with abscesses not accessible percutaneously may require surgical drainage and lavage.
Rectal stump blowouts can be managed with transrectal or transabdominal drainage. Unstable patients or patients with abscesses not accessible percutaneously may require surgical drainage and lavage with rectal stump closure.
Postoperative bleeding should be monitored closely with blood transfusions as needed.
Postoperative ileus should be managed conservatively with limitation of narcotic use and bowel rest until return of bowel function.
Bowel obstructions in the immediate postoperative period may be managed operatively. Patients presenting with bowel obstructions beyond the initial 6-8-week postoperative period can be managed conservatively with bowel rest and hydration.
Thromboembolic events should be prevented with prophylactic heparin and or Lovenox in the perioperative period. Thromboembolic events should be managed with therapeutic anticoagulation.
Educational aid only. Verify every dose, indication, and guideline against current institutional protocol. This is not a substitute for clinical judgment.
