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    Bowel perforation following salpingectomy

     

    Injury to bowel during abdominal hysterectomy

    Facts

    A WOMAN IN HER LATE 40s underwent a total abdominal hysterectomy and bilateral pelvic and para-aortic lymphadenectomy in 2008 due to a diagnosis of cervical cancer. The operation was performed by a gynecologic oncologist at a Pennsylvania medical center. Four days later the patient was diagnosed with a perforation of the small bowel and had contamination of the peritoneal cavity and sepsis. She underwent emergency surgery with resection of 12.5 cm of her small bowel. The incision was left open and she required multiple debridement procedures.

    She has significant asymmetrical bulging and other disfigurement of her torso, and underwent several procedures for hernias during the following 2 years. The patient claims she is at risk of future hernias and that plastic surgery has been recommended to remedy her disfigurement.

    In the lawsuit that followed, the patient claimed the bowel perforation occurred during the operation as a result of electrocautery use. She maintained that the defendants should have recognized the bowel injury earlier, and that it should have been detected during surgery. This would have avoided many of her subsequent injuries and complications.

    The defense claimed that the bowel injury was a known complication of this operation and that it was recognized and appropriately treated. They contended that it was not necessary to run the bowel at the conclusion of the operation.

    The verdict

    A defense verdict was returned.

    Thermal burn blamed for bowel perforation

    Facts

    A 55-YEAR-OLD ILLINOIS WOMAN underwent an operative hysteroscopy, dilation and curettage, and endometrial ablation in 2007, performed by her gynecologist. The procedure was done to address complaints of heavy and irregular bleeding. The patient returned to the hospital 2 days later with severe abdominal pain. She was diagnosed with a perforated rectosigmoid colon and underwent surgery the next day to repair the colon. A Hartmann’s procedure and colostomy were performed.

    The operative report for the repair described a hole in the uterus that appeared burned. The pathology report found that the cause of the colon perforation was acute perforated diverticulitis. The patient underwent another surgery several months later to reverse the colostomy and three subsequent operations were required to repair incisional hernias.

    The woman sued the gynecologist and hospital, claiming that they improperly seated the array device, utilized the device with a contraindicated uterine measurement after miscalculating the size of her uterus, and caused a thermal injury to the uterus and colon. The patient claimed that the colon perforation was not due to diverticulitis, but instead, was caused by an indirect thermal injury.

    The physician and medical center claimed that the uterus and colon were not burned and endometrial scarring observed by the surgeon performing the colon repair can mimic the appearance of a burn. They also claimed that the cause of the bowel perforation was diverticulitis.

    The verdict

    The hospital settled for $162,500 shortly before trial and a jury returned a defense verdict for the physician.

     

    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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