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

Background 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. Methods 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. Results Among 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). Conclusions 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.