Legal: Lack of informed consent for rectocele repair alleged

March 1, 2009

A woman sues gynecologist for alleged lack of informed consent.

A Virginia woman saw a new gynecologist for an annual exam in 2000. She was 43-years-old and had a history of multiple pelvic surgeries, including left ovary removal, hysterectomy, right ovary removal, and lysis of adhesions. She also had two vaginal deliveries in the early 1980s. At this visit, she complained of abdominal/pelvic pain and pressure and urinary incontinence. She had a history of constipation, but did not report that to the doctor. On examination and the physician noted a thin sphincter, a cystocele, and a urethrocele. The patient continued to be seen by this doctor over the next year with the same complaints. Surgery was scheduled for 2001 for lysis of adhesions, tension-free vaginal tape with cystoscopy, and posterior repair, which included a rectal plication/sphincteroplasty. At the preoperative visit, the patient signed a consent form for all three procedures, but later claimed that she thought the only procedure to be performed was a "bladder tuck." Three weeks after the procedure, the patient returned complaining of fecal incontinence. She was referred to a colon and rectal surgeon who performed an ultrasound which showed a defect on the anterior side of the sphincter. He performed an overlapping sphincteroplasty, but the patient continued to complain of fecal incontinence. She underwent a colostomy 11 months after the original procedure. She was treated for her colitis, and the colostomy was taken down after 9 months. While she has better control, she continues to complain of fecal incontinence.

The woman sued the gynecologist and alleged lack of informed consent for the rectocele repair and claimed negligence in performing the procedures. She also claimed that the rectocele repair was unnecessary.

The physician argued that the surgery was needed and the patient was fully informed of the risks of the surgery. She also claimed the patient's fecal incontinence was due to several factors and was likely precipitated by changes in her bowel motility and consistency, not from the operation. A defense verdict was returned.