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Medical Verdicts


Episiotomy, fourth-degree tear lead to colorectal surgery

October 2003 · Vol. 15, No. 10

<court>Plymouth County (Mass) Superior Court</court>

A 49-year-old woman delivered her second child vaginally after a previous cesarean section. During delivery, she required an episiotomy and experienced a fourth-degree tear.

Six days after her discharge, the patient’s husband called the doctor to report that his wife was suffering from severe constipation. The doctor advised him to give her an enema. The first enema had no effect, so a second one was administered. Later, the woman experienced a bloody bowel movement. The doctor diagnosed her with cloaca, a merger of the vaginal and rectal openings. She was referred to a colorectal surgeon to repair the condition.

At the time of trial, the patient said she continued to suffer from incontinence and had not engaged in sexual intercourse due to pain. She claimed that the doctor failed to advise her of the risks of an episiotomy or instruct her on how to care for the site. In addition, she contended that she was discharged without having a bowel movement. Further, she argued that recommending an enema without conducting an examination violated the standard of care. She said the enema’s hard nozzle may have caused trauma to the tissue and damaged the episiotomy.

The doctor argued that the bowel movement caused the problem, not the enema, and observed that an enema is the safest and most effective way to treat constipation.

  • The jury returned a defense verdict.

The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts. While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

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