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    Bowel perforation following salpingectomy


    Claim of misdiagnosis of ectopic pregnancy


    A 36-YEAR-OLD CALIFORNIA WOMAN went to the emergency department (ED) of a hospital in 2010 with complaints of lower abdominal pain with prior vaginal spotting. Her pregnancy test was positive. An ultrasound (U/S) showed milk thickening of the endometrium and a 1.5-cm right ovarian cyst. The patient returned to the hospital 5 days later and another U/S was performed, which revealed a 4-mm round fluid collection in the fundus of the uterus. Her beta-hCG level had risen appropriately. She was told to follow up in 2 days to have her hormone level rechecked.

    A little over a month later the woman went to a physician’s office to be examined. The obstetrician performed an U/S, found the uterus empty, diagnosed a double-ring structure in the adnexa as an ectopic pregnancy, and recommended an immediate injection of methotrexate to terminate the ectopic pregnancy and prevent rupture of the fallopian tube. The injection was given by the nurse and the patient’s blood was drawn to check hormone level, which had risen appropriately. The patient returned a week later and was seen by a different physician; another U/S showed an empty uterus, but her beta-hCG level had increased.

    The first obstetrician learned of the results and called the patient to tell her that she needed immediate laparoscopic surgery and a D&C to remove the ectopic pregnancy. The patient went to an ED at another hospital 3 days later, where U/S showed a 12-mm gestational sac in the uterus, a yolk sac, and a small embryo with no cardiac activity. She then underwent a D&C.

    The woman sued the obstetricians and their group, claiming that fetal demise was caused by the methotrexate injection and the physicians were negligent in misdiagnosing her viable pregnancy, leading to the loss of the pregnancy. The matter ultimately proceeded to trial against the doctor who recommended the methotrexate only, and it was alleged that he had misread the U/S and had failed to wait for the patient’s hormone reading before ordering the injection.

    The obstetrician denied any negligence and maintained that the patient had undergone two U/S that were unable to confirm an intrauterine pregnancy and that the hormone levels were such that an U/S should have shown a pregnancy if everything were normal. He also contended that the patient’s complaints of vaginal bleeding and right-lower-quadrant abdominal pain prior to being seen had led other physicians to also suspect an ectopic pregnancy. He additionally maintained that the pregnancy was most likely not viable in any event.

    The verdict

    A defense verdict was returned.

    Ureter injury during hysterectomy


    A NEW YORK WOMAN was age 43 when her gynecologist performed a hysterectomy for fibroids in 2008. Two days later she was diagnosed with left ureter obstruction, which caused damage to the bladder and necessitated extensive treatment.

    In her lawsuit against those involved with the hysterectomy, the woman claimed that the ureteral injury was due to a clamp used during the operation. She also claimed that the ureters were not properly protected because the arteries were clamped and sutured before the ureters had been identified, according to the operative report. The patient’s expert maintained that the ureters should be identified before the arteries are sutured and clamped.

    The gynecologist claimed that the injury is a known risk of the procedure and that the proper sequence was used during the operation, although an assisting physician might have erroneously documented the sequence of events. The defense attorney also claimed that the operation was complicated by the patient’s fibroids, which distorted the anatomy. Additionally, he maintained that the damage to the ureter could have been caused by a kink in the ureter or during the procedures performed by a subsequently treating urologist.

    The verdict

    A $526,088 verdict was returned.


    Dawn Collins, JD
    MS COLLINS is an attorney specializing in medical malpractice in Long Beach, California. She welcomes feedback on this column via ...


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