Legal: When a D& E injures the colon

March 1, 2009

During a D&E procedure, the sigmoid colon was briefly pinched by the ring forceps.

IN 2004, A 23-YEAR-OLD ILLINOIS WOMAN had a fetal demise at about 16 weeks' gestation. Her obstetrician had performed a D&E procedure after insertion of laminaria the day before. During the procedure, the uterine was perforated and part of the sigmoid colon was briefly pinched by the ring forceps. The pinching caused a vascular disruption and ischemic area to the colon, although there was no laceration to the colon itself. The obstetrician recognized that some complication had occurred and immediately converted to a laparoscopy and called a general surgeon to assist. The scope revealed a 1.5- to 2-cm perforation in the fundus and some bluish discoloration of the mesentery. The general surgeon opted to resect the colon and perform a temporary colostomy. The colostomy was successfully reversed 3 months later. The woman subsequently gave birth to a child by cesarean and has three abdominal surgical scars.

She then sued the obstetrician who performed the D&E, alleging negligence in pulling the colon into the uterus and clamping it, causing her to have the temporary colostomy and thus the scars.

The physician asserted that the perforation was a known complication of the D&E, that the colon was accidentally grasped for less than a minute, and the woman has no long-term injury. The jury returned a defense verdict.