Vesicovaginal fistula following hysterectomy

January 9, 2008

A 45-year-old Illinois woman underwent a total abdominal hysterectomy in 2005. Toward the end of the procedure the nurse anesthetist reported blood in the catheter tubing and bag, which the gynecologist attributed to a traumatic catheterization at the start of the procedure. The patient continued to have blood in her urine and urinary leakage. Two days later a 4- to 5-cm laceration at the base of the bladder was found. While several attempts were made to surgically repair the laceration, she developed a vesicovaginal fistula that continued for about 8 months. The laceration/fistula was eventually successfully repaired and the patient has been leak-free since then.

A 45-year-old Illinois woman underwent a total abdominal hysterectomy in 2005. Toward the end of the procedure the nurse anesthetist reported blood in the catheter tubing and bag, which the gynecologist attributed to a traumatic catheterization at the start of the procedure. The patient continued to have blood in her urine and urinary leakage. Two days later a 4- to 5-cm laceration at the base of the bladder was found. While several attempts were made to surgically repair the laceration, she developed a vesicovaginal fistula that continued for about 8 months. The laceration/fistula was eventually successfully repaired and the patient has been leak-free since then.

The woman sued the operating surgeon and claimed that her failure to detect and respond in a timely manner to the laceration led to the development of the fistula.

The physician contended that the laceration was not detected because of its location and that the proper treatment for a laceration discovered after closing was to drain the bladder with a catheter and allow the laceration to heal on its own in a couple of weeks. The verdict was for the patient and $300,000 was awarded.

—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.