Bowel injury during hysterectomy

A 41-YEAR-OLD GEORGIA WOMAN underwent a laparoscopic hysterectomy, which included removal of some endometriosis implants. A gynecologic surgeon performed the operation. During the operation, defects were created in the large and small bowel as a consequence of the removal of an endometrial nodule that had adhered to the terminal ileum and rectosigmoid colon. Surgeons recognized the defects intraoperatively, and repairs were attempted using a running, locking suture. The patient was discharged from the outpatient facility 23 hours after surgery.

Five days later, the woman was diagnosed with bowel perforations at the repair sites and peritonitis. She required emergency surgery and a temporary colostomy, which was reversed several months later.

The woman sued the surgeon, claiming that he used an inappropriate stitching technique, that he should have consulted a bowel surgeon for assistance with the initial repair, and that she should have been hospitalized for observation after the surgery.

LEGAL PERSPECTIVE In situations where a known complication occurs, the issues in a malpractice case are usually whether the patient had reasonable informed consent for the procedure and whether the complication was recognized in a timely manner and appropriately managed.

In this case, there was no mention of a lack of informed consent claim, and the injury to the bowel was recognized intraoperatively, so the main issue became the management of the complication. The stitching technique would be a subject for each side's expert witnesses to debate, as well as whether requesting a bowel surgeon might have been within the standard.

Sending the patient home 23 hours after surgery may have seemed cavalier in retrospect, and documentation of discharge instructions and any follow-up with the patient would be crucial.

Although the patient had no long-term damages from the second operation, the jury would consider the colostomy and its reversal.

MS COLLINS is an attorney specializing in medical malpractice in Long Beach, California. She welcomes feedback on this column via e-mail to dawncfree@gmail.com
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