{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T18:38:35Z","timestamp":1792694315009,"version":"4.5.0"},"reference-count":37,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cesarean 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 3\u00a0816\u00a0895 cesarean deliveries, 8891 involved a documented GI\/URO injury requiring surgical intervention (\u2248233 per 100\u00a0000). 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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>GI\/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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348261500322","type":"journal-article","created":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T02:11:28Z","timestamp":1792462288000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Gastrointestinal and Urological Tract Injuries During Cesarean Delivery: A Surgical Review With National Epidemiologic Data"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6055-7121","authenticated-orcid":false,"given":"Ahmad","family":"Zeineddin","sequence":"first","affiliation":[{"name":"R. Adams Cowley Maryland Shock Trauma, University of Maryland School of Medicine, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0908-4062","authenticated-orcid":false,"given":"Mariana N.","family":"Olivencia-Delgado","sequence":"additional","affiliation":[{"name":"Howard University College of Medicine, Howard University Hospital, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kindha E.","family":"Nasef","sequence":"additional","affiliation":[{"name":"Howard University College of Medicine, Howard University Hospital, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Carmona-Tamayo","sequence":"additional","affiliation":[{"name":"Howard University College of Medicine, Howard University Hospital, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kendra","family":"Outler","sequence":"additional","affiliation":[{"name":"John H. 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