Complications of Breast Surgery
Although overall rates of complications are low following breast surgery, wound infections, hematomas, seromas, pneumothorax, and necrosis of the skin flaps may be seen. Lymphedema of the ipsilateral arm may occur after mastectomy.
Complications of Gastrointestinal Surgery
Stimulation of the splanchnic nerves during intraabdominal surgery may lead to dysmotility and a paralytic ileus. After gastrointestinal surgery, small bowel tone returns to normal within 24 hours and colonic function within 3 to 5 days.
Patients develop nausea, vomiting, constipation, abdominal distention and pain. An adynamic ileus typically resolves after bowel rest, nasogastric suction and intravenous hydration. Prolonged ileus should prompt an investigation for nonneuronal causes like peritonitis, intra-abdominal abscesses, hemoperitoneum, pneumonia, sepsis, electrolyte imbalance, or medications. Abdominal imaging, complete blood cell count, electrolytes, blood urea nitrogen, creatinine, and urinalysis should be obtained. Occasionally, surgical intervention may be necessary for obstruction due to adhesions.
Intraabdominal abscesses are caused by preoperative contamination, intraoperative spillage of bowel contents or postoperative anastomotic leaks. Diagnosis can be confirmed by computed tomography or ultrasonography. Antibiotic therapy as well as either percutaneous or surgical drainage will be required.
Pancreatitis occurs especially after direct manipulation of the pancreatic duct. The clinical spectrum extends from mild nausea and vomiting to severe abdominal pain and hemodynamic instability. Complications like pleural effusion and severe hemorrhage may occur. Serum amylase measurements are not specific and measurement of a lipase is more reliable.
Cholecystitis and biliary colic have been reported as postoperative complications. Elderly patients are more prone to develop acalculous cholecystitis. Characteristic lab findings of a calculous or obstructive process may be absent.
Fistulas, internal or external, may result from either technical complications or direct bowel injury. Fistulas can lead to electrolyte abnormalities and require surgical consultation and possible hospitalization. Anastomotic leaks occur primarily after esophageal, gastric and colonic procedures and can cause devastating consequences as a result of infection. Esophageal leaks occur within 10 days of the operation and carry very high morbidity and mortality.
Complications of bariatric surgery remain common although mortality after the procedures is low. In the weeks after surgery, patients are at risk for leaks and bleeding. Dumping syndrome is seen in gastric bypass procedures due to the rapid influx of hyperosmolar chyme into the small intestine resulting in fluid sequestration and hypovolemia. Patients experience nausea, vomiting, epigastric discomfort, palpitations, dizziness, and sometimes syncope. Other complications include gastroesophageal reflux, vitamin and electrolyte deficiencies, ulcers, obstruction, gastric slippage, and band erosion.
Complications of laparoscopic procedures include problems related to pneumoperitoneum, traumatic injury from insertion of the needle and trocar, and retained stones after cholecystectomy.
Complications of transabdominal feeding tubes and percutaneous endoscopic gastrostomy tubes include infections, hemorrhage, peritonitis, aspiration, wound dehiscence, sepsis, and obstruction of the tube. Dislodged tubes should be replaced with the appropriately sized tube (same type if possible, or a temporary foley catheter).
Acute complications arising from stomas (ileostomy or colostomy) are usually due to technical errors of stoma placement. Later complications can be from the underlying disease such as Crohn's disease or cancer. Ischemia, necrosis, skin maceration, bleeding, parastomal hernia, and prolapse may be seen.
The most common complications of colonoscopy are hemorrhage and perforation. Hemorrhage occurs typically due to polypectomy, biopsies, or mucosal lacerations or tearing. Perforation may be immediately apparent or symptoms may be delayed for several hours to days. Upright chest or abdominal radiographs may reveal free air but CT should be obtained if the films are unrevealing and suspicion is high.
Rectal surgery complications include urinary retention (frequently after hemorrhoidectomy), constipation, prolapse, bleeding, and infections.
Tetanus has been known to occur in surgical wounds although, by far, this rare disease is more common after minor trauma.