A Displaced Intrauterine Device Eroding Into the Sigmoid Colon.

A 36-year-old female presented to the gynecology office eight weeks after the placement of a ParaGard intrauterine device (IUD). Upon gynecologic examination, the strings of the IUD were not found. Magnetic resonance imaging was performed which reported the IUD embedded in the sigmoid colon. Initial diagnostic laparoscopy was done without bowel preparation and revealed an IUD embedded within the sigmoid colon and mesocolon. Colonoscopy did not reveal any breach of the colonic lumen. A second diagnostic laparoscopy was planned with the robotic-assisted technique after bowel preparation. Intraoperative findings during the second operation identified the IUD embedded in the antimesenteric side of the sigmoid colon with surrounding scar tissue to the uterus. The IUD was sharply freed using robotic scissors and the resulting serosal defect was sutured in layers with buttress made of appendices epiploica. The patient recovered well and had an excellent outcome. Our article highlights the minimally invasive method of dealing with a displaced IUD. The use of the robotic technique was helpful in our case to achieve an excellent outcome.

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

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.