Was exploratory laparotomy unnecessary?

November 12, 2007

A woman in her early 40s went to a Missouri hospital with complaints of right-sided pelvic pain in 1999. Ultrasound evaluation of the pelvis ruled out appendicitis, but the report indicated a history by the patient of a hysterectomy and bilateral oophorectomy, and the scan revealed a total absence of the uterus and both ovaries. The patient continued to have pain and went to the emergency room and doctor's offices over the next 2 years.

A woman in her early 40s went to a Missouri hospital with complaints of right-sided pelvic pain in 1999. Ultrasound evaluation of the pelvis ruled out appendicitis, but the report indicated a history by the patient of a hysterectomy and bilateral oophorectomy, and the scan revealed a total absence of the uterus and both ovaries. The patient continued to have pain and went to the emergency room and doctor's offices over the next 2 years.

In 2002, she went to the emergency room of another hospital with complaints of lower left pelvic pain. She was examined, underwent a CT scan, blood tests, and urinalysis, and all test results were normal. She was then sent to the original hospital the next day for an U/S and was instructed to follow up with her gynecologist. The U/S at that time was read as normal, but it revealed the presence of a left ovary. The clinical history given by the patient was of a hysterectomy and questionable right salpingo-oopherectomy. The radiologist recommended correlation with her operative records. Five days later, the woman went to a family doctor, who stated she might need an exploratory laparotomy and the same day her gynecologist recommended an exploratory laparotomy to find the source of her pain. He stated that he would remove the left ovary and scar tissue if encountered. The laparotomy was performed later that month and adhesions were found to be binding the bowel to the pelvic wall. These were lysed, and no ovary was found. The physician sought an intra-operative consultation from a partner and was told the appearance on the U/S could be caused by shadows from the adhesions, a loop of bowel, or other soft tissue in the pelvis. The operation was concluded, and the patient was sent to recovery.

The woman sued the hospital and her gynecologist, claiming he failed to rule out other potential causes for her pain before proceeding to surgery and failed to investigate the reported left ovary. She also claimed the radiologist failed to alert the ordering physician to the discrepancy in the histories given and the findings related to the left ovary, and he should have recommended further evaluation by a repeat U/S and/or transvaginal U/S. The patient claimed she had undergone unnecessary surgery.

The hospital was granted a directed verdict and the remaining defendants denied negligence and contended that the patient had a long history of pain without a known cause. The gynecologist contended that even though she had a history of removal of both ovaries, ovarian tissue can be left behind and ovarian tissue remnants can re-grow, so the U/S report of the presence of a left ovary was not a surprising finding. He claimed that his decision to perform surgery was proper and necessary to discover the source of the pain. The radiologist asserted that the physicians were aware of the conflict between the U/S and claimed that the surgery would have been performed in any instance. A defense verdict was returned. An appeal was pending.