Case 2002: Bowel Obstruction

Published on




On September 17, the Plaintiff, a 45 year old female, was admitted to the Defendant Hospital for a planned laparoscopic hysterectomy. She underwent the procedure the next day.  The Plaintiff alleged that the Defendant Hospital’s gynecology service fell below accepted standards of care in failing to appropriately evaluate her for the possibility of a minimally invasive procedure rather than surgical  hysterectomy to address her uterine fibroids.  Due to her prosthetic mitral valve, the Plaintiff was a high surgical risk candidate, on anticoagulant medication with a significant risk of operative bleeding.  However, her physicians failed to perform tests and studies including, but not limited to a sonohysterogram, to determine whether she was an appropriate candidate for global endometrial ablation.  A sonohysterogram would have demonstrated uterine fibroids which were amenable to endometrial ablation without the need for surgical hysterectomy, as confirmed by the surgical pathology.

Postoperatively, the Plaintiff developed a large hematoma, confirmed by CT scan on September 21, which resulted in bowel obstruction and, ultimately, the injuries and damages complained of in the Plaintiff’s Complaint.

Between the procedure and September 28, the Plaintiff exhibited signs and symptoms of abnormal gastrointestinal function (nausea, vomiting, abdominal pain) which, on September 28, was confirmed to be a small bowel obstruction.  Accordingly, a surgical consultation took place on September 29, along with an additional CT scan which confirmed a high grade small bowel obstruction.  The Defendant did not intervene surgically.  Instead, he undertook care of the Plaintiff for the high grade small bowel obstruction with non-operative management.  He placed a nasogastric tube for decompression in addition to an increase in intravenous fluids and parenteral nutrition.  From September 29 through October 10 the Plaintiff continued with her obstruction.

Finally, on October 10, the Defendant took the Plaintiff to an operating room for exploratory laparotomy.  Upon entering the abdomen, he encountered extensive adhesions of the small and large bowel with obvious, multiple closed loop obstructions — all due to the inflammatory response created by the ongoing hematoma.  During the procedure, frank spillage of bowel contents into the abdomen occurred intraoperatively.  Due to the massive amount of adhesions and the resulting intraoperative bowel injuries, the procedure was terminated after the Defendant performed a small and partial large bowel resection, including removal of the cecum and ileocecal valve.  The amount of bowel removed totalled over four feet, leaving the Plaintiff will short gut syndrome.

The Plaintiff alleged that the Defendant surgeon negligently failed intervene in a timely fashion with a surgical repair of the high grade, documented, small bowel obstruction which had not been relieved through any prior medical management.

As a result of the negligence of these Defendants, the Plaintiff suffers with a short gut syndrome.  She suffers with regular nausea as well as gas and pain, and still passes stool an average of 6-7 times per day.  She is unable to control her stool, and, as a result, is severely limited in any activities which she enjoyed previously.  Additionally, she requires multiple medications in an effort to manage her condition and provide additional nutrition which she is unable to absorb due to her short gut syndrome.  Finally, it was alleged that the Plaintiff was permanently disabled from gainful employment in addition to her regular activities.