Nine days after what appeared to be an uncomplicated myomectomy, a 32-year-old woman returned with severe abdominal pain, vomiting and distension. What followed turned a familiar surgical product into the centre of an unexpected complication.
When an uncomplicated myomectomy took an unexpected turn
Dr. Mohini Abreo presented the case of a 32-year-old woman with heavy menstrual bleeding and multiple fibroids. After GnRH priming, she underwent myomectomy, including removal of a difficult low posterior fibroid. Hemostasis was achieved and Surgicel was placed over the suture lines.
The immediate postoperative period was uneventful. On day nine, however, she presented with acute abdominal pain, nausea, vomiting and distension. Imaging showed intestinal obstruction.
Emergency laparoscopy revealed extensive small-bowel adhesions and necrotic tissue, with Surgicel embedded within the adhesions. The surgeons subsequently performed a laparotomy, resected a small perforated bowel segment and performed an anastomosis. Her recovery was prolonged by sepsis and hypoalbuminemia.
Reflecting on the case, Dr. Mohini said,“Surgicel should be used judiciously.”
She also highlighted how placement mattered in this case. The posterior fibroid was low and deep, making displacement of the Surgicel possible. Her takeaway was that it should be “moist and properly applied to the surgical site to prevent migration and floating in the peritoneal cavity.”
Another patient, another warning
Dr. Rekha Upadhya shared a separate experience after adnexectomy. The patient developed abdominal distension after initially recovering well. Imaging suggested bowel narrowing, but once the team informed radiology that Surgicel had been used, the findings were interpreted differently and conservative management was possible.
Dr. Rekha recalled that the experience changed their practice. They began using smaller pieces, trimming the material and placing it precisely where required.
Why postoperative pain cannot be dismissed
The panel also discussed a post-hysterectomy patient who returned with severe episodic pain. Imaging revealed significant obstruction, with a long segment of bowel becoming gangrenous. Dr. Rekha stressed the value of early multidisciplinary intervention, noting that “interdisciplinary definitely helps in these patients, rather than alone handling.”
Dr. Charmila added another caution - emergency postoperative complaints can be deceptively easy to dismiss. Her message was clear - “It’s always better to error on the higher side, so that you don’t miss out on such cases.”
The lesson was not simply to stop using hemostatic agents, but to understand when they are needed, how they are placed, and when an unexpected postoperative symptom deserves immediate escalation.