Perforated uterus during hysteroscopy

April 17, 2008

A 46-year-old New York woman went to her gynecologist in 2002 with a complaint of excessive bleeding during her last menstrual period. A hysteroscopy with dilation and curettage was recommended and performed about a month later. The operative report revealed uterine fibroids and also evidence of an endometrial polyp. A sharp curettage was carried out. The endometrial polyp was excised using polyp forceps and the tissue was sent to pathology. The patient was stable, but after the operation began to complain of severe abdominal pain. She was given oxycodone with acetaminophen by mouth and morphine IV. Her gynecologist was called and a resident was notified of the patient’s condition. The resident recommended IV ketorolac tromethamine. The gynecologist returned the call but did not evaluate the patient, and she was discharged home.

A 46-year-old New York woman went to her gynecologist in 2002 with a complaint of excessive bleeding during her last menstrual period. A hysteroscopy with dilation and curettage was recommended and performed about a month later. The operative report revealed uterine fibroids and also evidence of an endometrial polyp. A sharp curettage was carried out. The endometrial polyp was excised using polyp forceps and the tissue was sent to pathology. The patient was stable, but after the operation began to complain of severe abdominal pain. She was given oxycodone with acetaminophen by mouth and morphine IV. Her gynecologist was called and a resident was notified of the patient’s condition. The resident recommended IV ketorolac tromethamine. The gynecologist returned the call but did not evaluate the patient, and she was discharged home.

The woman called the physician twice with complaints of severe abdominal pain and was advised to take acetaminophen and call in the morning if the pain persisted. When she called the next morning, still complaining of severe abdominal pain, she was told to come to the office from whence she was sent to the emergency room. That morning the pathologist called her physician and informed her that the endometrial sample was actually fragments of small bowel and that the presumed endometrial polyp was actually a loop of small bowel. The patient then had an abdominal x-ray, which revealed free air in the abdomen. A diagnostic laparoscopy was performed by the gynecologist, which revealed a uterine perforation and a 3-cm small bowel defect, as well as the presence of intra-abdominal bowel contents. A general surgeon was called and performed a laparotomy, lysis of adhesions, resection of approximately 36 cm of small bowel with reanastamosis of the small bowel. The woman was treated with antibiotics and was hospitalized for 10 days. She continued to complain of severe abdominal pain, loss of bowel function, depression, and nightmares.

The patient sued the hospital and physician and claimed that she had perforated the small bowel and uterus during the operation and failed to recognize it at the time. She also claimed the gynecologist failed to investigate her complaints of severe abdominal and back pain.

A settlement was reached with the hospital for $120,000. The physician claimed the perforation of the uterus and small bowel are known complications of a dilation and curettage and they were timely and properly diagnosed and treated. Further, the patient was healed and her surgical scar was minor. A $477,677 verdict was returned for the woman.

—Department Editor Dawn Collins, JDMs. Collins is an attorney specializing in medical malpractice in Long Beach, CA.
She welcomes feedback on this column via email to DawnCF@aol.com.