[Bowel perforation during placement of a tension-free vaginal tape for stress urinary incontinence]. / Darmperforatie bij het plaatsen van een tensievrij vaginaal bandje wegens stressincontinentie.

A 46-year-old non-obese woman with no previous history of pelvic surgery underwent a tension-free vaginal tape (TVT) procedure for the treatment of stress urinary incontinence. Perioperative cystoscopy revealed that both trocars had perforated the bladder. The procedure was cancelled due to excessive bleeding in the bladder, which impaired visibility by cystoscopy. Postoperatively the patient had increasing abdominal pain, anaemia and a tendency to collapse. Laparotomy was performed and, in addition to a haematoma in the retropubic space, 2 perforations were detected in the small intestine; these perforations were closed. Bowel perforations during TVT procedures are rare but sometimes fatal. They have been described in the literature and appear to be under-reported. Patients typically develop symptoms immediately after surgery, but some exceptional cases may develop symptoms after a few months. Bowel perforation should be considered when unexplainable symptoms arise after a minimally invasive procedure like TVT. Because this rare complication can be life-threatening, early recognition is very important.