Missed bowel injury follows laparoscopy
<court>Nevada County (Calif) Superior Court</court>
A 40-year-old woman with focal endometriosis underwent laparoscopy with biopsy of the cul de sac and left ovary, laser endometrial ablation, and left paratubal cyst resection.
Several hours after being discharged that same day, the woman presented to the emergency room with severe abdominal pain, nausea, and vomiting. She displayed no respiratory problems and her abdomen was soft. She was admitted for intravenous pain control and released the following day.
The woman returned the next day, noting a worsening of her pain, nausea, and vomiting. Her abdomen was now significantly distended, which led to reduced respiratory effort. Suspecting mild postoperative ileus and possible early pancreatitis and hyponatremia, the attending Ob/Gyn called in a general surgeon.
Upon opening the abdominal cavity at laparotomy, the surgeon observed an outpouring of gas and noted a few thousand milliliters of brown, foul-smelling liquid. He discovered a perforation of the ileum. An ileostomy was placed during the procedure.
Following initiation of intravenous feeding, the woman suffered sepsis and acute respiratory distress syndrome. She became desaturated and was intubated for the next 2 days. She suffered wound infection at the ileostomy site, acquired nosocomial pneumonia following extubation, and developed multicentric hernias requiring surgical mesh implantation. She was hospitalized for 1 month.
The woman claimed her Ob/Gyn was negligent in perforating the ileum, as well as in failing to recognize the injury and treat the bacterial peritonitis in a timely manner.
The defense argued no indications of bowel perforation and peritonitis were present, and noted that postoperative x-rays were consistent with ileus, a more common complication.
- The jury returned a defense verdict.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.