Gastrointestinal and Urological Tract Injuries During Cesarean Delivery: A Surgical Review With National Epidemiologic Data.

Authors

Ahmad Zeineddin, Mariana N Olivencia-Delgado, Kindha E Nasef, Juan Carmona-Tamayo, Kendra Outler, Mallory Williams

Published in

The American surgeon. Pages 31348261500322. Oct 19, 2026. Epub Oct 19, 2026.

Abstract

BackgroundCesarean delivery is the most common major surgical procedure performed worldwide, accounting for approximately one-third of US deliveries. Gastrointestinal (GI) and urological (URO) tract injuries are uncommon but disproportionately morbid complications. Increasing complexity, particularly repeat cesarean and placenta accreta spectrum (PAS), and uneven on-site subspecialty coverage have expanded the role of general surgeons as intraoperative consultants for these injuries, especially outside large tertiary centers.MethodsWe analyzed the National Inpatient Sample (NIS, 2005-2019) to characterize the contemporary epidemiology, predictors, and outcomes of GI/URO injuries during cesarean delivery, complemented by a literature review focused on intraoperative recognition and management principles most relevant to the consulting general surgeon.ResultsAmong 3 816 895 cesarean deliveries, 8891 involved a documented GI/URO injury requiring surgical intervention (≈233 per 100 000). Bladder injuries predominated (78.2%), followed by bowel repair (13.3%), bowel resection (7.8%), and ureteral injuries (1.3%). Injuries were associated with markedly higher ICU admission (3.4% vs 0.2%), respiratory failure (1.7% vs 0.1%), in-hospital mortality (0.22% vs 0.01%), and resource utilization. Prior cesarean delivery was the strongest predictor of URO injury (OR 2.92; 95% CI 2.71-3.13).ConclusionsGI/URO injuries during cesarean delivery are uncommon but highly morbid, and the operative complexity that produces them is rising. With variable on-site subspecialty coverage, the general surgeon is frequently the first operative consultant. Familiarity with intraoperative principles, prevention strategies in high-risk cases, structured recognition, and initial repair or damage-control temporization should be considered a core competency for surgeons covering trauma, rural, or emergency general surgery call.

PMID:
42897086
Bibliographic data and abstract were imported from PubMed on 20 Oct 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.