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Medical Verdicts


Bladder injury leads to fasciitis, death

October 2004 · Vol. 16, No. 10

<court>Undisclosed County (Mass)</court>

After unsuccessfully attempting to conceive, a 40-year-old woman consulted an infertility specialist. Suspecting adhesions, the physician performed a laparoscopy—without catheterization of the bladder, as he expected a quick procedure.

Due to the discovery of a large uterine fibroid, however, the surgery ultimately extended to more than 2 hours. While attempting to remove the fibroid, the surgeon dropped it deep into the peritoneal cavity, but retrieved it after several attempts.

The woman was sent home the same day, despite considerable pain, difficulty voiding, and significant drainage from the incision site. The following morning, however, her symptoms had intensified. The Ob/Gyn’s office thus instructed her to go to the emergency room.

Soon after presenting, she was admitted into surgery, where 2 bladder perforations were discovered. Physicians determined that, at the time of laparoscopy, the woman had a bladder infection. Thus, the perforations were leaking infected urine into the abdominal and peritoneal cavities. This caused peritonitis, sepsis, and wound infection that proved resistant to antibiotic therapy.

The woman ultimately developed necrotizing fasciitis and, despite several attempts at debridement, died 2 months after the initial laparoscopy.

In suing, the woman’s husband argued the physician was negligent for not catheterizing the patient prior to surgery. He claimed that the doctor did not notice the bladder was filling with urine during the extended surgery, thus changing the bladder’s position. Finally, he argued, the Ob/Gyn failed to notice the signs of bladder perforation and the leaking of infected urine in the recovery room.

The defendant maintained he was within the standard of care by not catheterizing the patient, and argued that necrotizing fasciitis is a rare condition that cannot be predicted.

  • The case settled for $1.9 million.

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.

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