A working familiarity with the management of common perioperative gastrointestinal complications is required for all general gynecologists. Thermal gastrointestinal injury requires resection of the damaged portion of bowel unless the injury involves only the bowel serosa and is less than 0.5 cm in diameter. Small intraoperative
lacerations of the intestine can be closed primarily, whereas larger
lacerations often require resection. Some degree of postoperative
ileus may be expected, but prolonged
ileus requires nasogastric suctioning while excluding bowel obstruction,
peritonitis, or
electrolyte imbalance. Small-bowel obstruction, most likely to be caused by postoperative adhesions, can often be treated successfully by gastrointestinal intubation. Steps required in the initial management of an
enterocutaneous fistula include institution of parenteral nutritional supplementation and
antibiotics, skin protection, and investigative studies of the
fistula. Preventive measures may be used at the time of any
surgical procedure to reduce the incidence of many of these complications.