Gallbladder surgery complications are not uncommon unfortunately and although none of the editors of InsideSurgery participated in his care, we have noted reports that Pennsylvania Congressman John Murtha has died from complications following removal of his gallbladder.
The Associated Press is reporting tonight that Pennsylvania Congressman Bob Brady of Philadelphia has stated that Murtha suffered from injury to his large intestine during the operation at Bethesda Naval Hospital to remove his gallbladder.
The gallbladder was reportedly removed laparoscopically or as it is sometimes described via a minimally invasive technique.
Murtha was apparently discharged to home and then presented to the Virginia Hospital Center complaining of abdominal pain and a fever.
Several days ago he was reported to be in the intensive care unit, indicating that one of a number of posssible serious gallbladder surgery complications had developed which he eventually succumbed to.
Despite being widely performed and viewed as a routine and straightforward operation by patients, laparoscopic cholecystectomy or gallbladder removal can be technically difficult to perform in certain situations.
There are many ways that injury to the intestines can occur in this procedure. An understanding of the anatomy of abdomen and the pathophysiology of gallbladder disease is useful.
The gallbladder is a sac-like structure hanging from a system of ducts leading from the liver in the right upper quadrant to the duodenum.
Immediately adjacent to the gallbladder is the hepatic flexure of the right colon.
When the gallbladder becomes inflamed, the walls of the gallbladder and the surrounding tissue literally becomes red and swollen and the normal tissue planes become obscured, particularly if there have been repeated attacks of cholecystitis or gallbladder inflammation.
To put it simply, “everything gets stuck together” including the gallbladder and colon.
When removing the gallbladder one of the first steps is to peel the colon off the underlying gallbladder wall, without tearing the colon in the process.
While large holes in the colon are fairly easy to notice, smaller perforations in a bed of inflamed tissue are easier to miss.
A second way that the colon can be injured resulting in gallbladder surgery complications is during the procedure is inadvertently perforating it with a retractor or dissecting instrument.
This generally occurs as the tissue is being gently pulled down off of the cystic duct. The sweeping motion of the grasper is towards the area of the colon, which may get “poked” by the tip of the retractor.
A third way the colon can be injured is through a thermal burn from the Bovie electrocautery used to stop localized bleeding from tissues.
This injury causing gallbladder surgery complications may present as a delayed finding and is not uncommon when patients re-present to the hospital with colon injury after being discharged home.