Legally Speaking: Was this myomectomy botched?

December 1, 2008

After the patient's third myomectomy, she sued, claiming the third surgery should have been an hysterectomy, but the physican successfully defended his actions in court.

THE FACTS

The patient was then a 36-year-old married, African-American woman who had been treated by the defendant obstetrician/gynecologist for over 20 years. The woman suffered from chronic recurrent uterine fibroids and first presented to the defendant with complaints of fibroids and heavy bleeding in 1981. Two ob/gyns who treated her in the past had suggested hysterectomy, but the defendant physician recommended myomectomy, which was done for the first time in 1981, after a long consent discussion. In 1993, the patient returned once again complaining of fibroids and heavy bleeding for several months, and since the patient said she wanted to eventually have children, preserving her uterus was crucial. The defendant ob/gyn warned her that a second myomectomy would weaken her uterus, which meant that any future babies would have to be delivered via cesarean. The patient agreed to the second procedure nonetheless.

IN THE SPRING OF 2002, the patient again presented with complaints of painful fibroids. She had undergone a series of hormone treatments in an unsuccessful attempt to help her conceive, and the defendant ob/gyn planned for a third myomectomy at the defendant Hospital Center. The third myomectomy took place on August 6, and according to the operative report, although extensive adhesions were found and dissected, surgery was performed without complications. Postoperatively, her WBC count rose to 19,000, and although she was discharged feeling the need to "pass flatus," she was in good condition. Upon returning home, the patient said she ate soup but later that evening began to experience abdominal swelling, discomfort, nausea, and vomiting. She called the defendant ob/gyn and presented to the emergency department late on the evening of August 8, and was re-admitted early the next day.

On August 12, the defendant ob/gyn ordered a soapsuds enema, but the RN involved in the patient's care-under the impression that an enema would be contraindicated for a possible small bowel obstruction-objected to carrying out the defendant's orders. As a result, an attending physician, Dr. C, and the aforementioned surgeon Dr. B were consulted, along with the defendant ob/gyn; all three signed off on the order and felt that an enema would not be harmful to the patient under the circumstances. At 1:25 PM on August 12, the enema was administered, and almost immediately thereafter, the patient's condition changed dramatically. Within 4 hours of the administration of the enema, the patient was running a fever of 101.3°F, became diaphoretic, and complained of excruciating abdominal pain. Approximately 9 hours later, she was transferred to the ICU with signs and symptoms suggesting shock. She continued to complain of acute abdominal pain, manifested signs and symptoms of peritonitis, and had produced no urine since the enema was administered.

On the morning of August 13, the patient was taken to the OR by Dr. B, who located and released the small bowel obstruction, which was in the area of the prior surgical incision. In addition, although there was no compromise to the small bowel, on further exploration, the surgeon found a through-and-through perforation in the sigmoid colon, at the top of the uterus, precisely in the area of the defendant ob/gyn's most recent myomectomy. Dr. B oversewed the hole with no evidence of necrosis, and performed a temporary ileostomy, which was reversed 2 months later, on October 12. The patient by all accounts, did well thereafter.