Case #1048: Bowel Perforation
On September 11, the Plaintiff’s Decedent, then 79 years old, presented to the Defendant Hospital for a laparoscopic ventral hernia repair. The Plaintiff’s Decedent agreed to the procedure which was completed on that day using mesh and spiral tacks
The Plaintiff alleged that during the course of the procedure, the surgeon negligently placed tacks such that they perforated the Plaintiff’s Decedent’s bowel. The Plaintiff alleged that during the course of such a procedure, the standards of care required these Defendants to identify, isolate and protect the bowel at all times. Further, the Plaintiff alleged that, prior to closing the patient, the Defendants were obligated to inspect the bowel to be sure that no damage had been inflicted. Contrary to the standards of care, the Defendants further failed to recognize the fact that they had damaged the bowel during the course of the laparoscopic procedure. The Plaintiff’s Decedent was taken to a recovery room and subsequently to a hospital room until September 13, at which time she was discharged with no recognition of the damage to the bowel which had been inflicted.
On September 17, at 1:45 in the afternoon, the Plaintiff’s Decedent presented to the emergency room of the second Defendant Hospital with complaints of severe abdominal pain, shortness of breath, decreased bowel sounds and a firm, distended abdomen. Notwithstanding a history of recent abdominal surgery just one week earlier, as well as signs and symptoms indicating an acute intra-abdominal process and surgical abdomen, the Defendant emergency room physician and duly authorized agents and/or employees of the Defendant Hospital, negligently failed to arrange for a surgical consult and surgical intervention in a timely manner. In fact, the Plaintiff alleged that the Plaintiff’s Decedent was allowed to linger in the emergency room without the benefit of appropriate surgical consult and evaluation until 10:55 p.m. — over nine hours from the Plaintiff’s Decedent’s initial presentation in the emergency room. Additionally, the Plaintiff alleged that these Defendants negligently delayed administration of appropriate antibiotic therapy and/or other treatment and/or intervention, and were further negligent in their continuing management of antibiotic coverage.
Finally, at midnight on September 18, the Plaintiff’s Decedent was belatedly taken to an operating room for an exploratory laparotomy at which time it was found that the Defendants had damaged the Plaintiff’s Decedent’s bowel during the course of the previous hernia repair. During the surgery at the second hospital, the Plaintiff’s Decedent’s abdominal cavity was noted to be severely distended with the bowel having been damaged through punctate openings. Multiple exudates and a hematoma were found in the area of injury to the bowel — all of which required the operating surgeon to perform a bowel resection — removing the perforated section of bowel and then completing an anastomosis. A subsequent pathology report confirmed that the bowel was perforated. Likewise, acute peritonitis was confirmed.
Notwithstanding the efforts on the part of the operating surgeons and hospital personnel, it is alleged that the injury and damages inflicted upon the Claimant’s Decedent were too great — ultimately leading to a downhill spiral, multi-organ failure and death on October 6. She was survived by one adult daughter.
The Defendants denied all allegations of negligence, causation and harm. Specifically, the first Defendant Hospital asserted that there was no intraoperative bowel injury during the surgery. Rather, the Plaintiff’s Decedent sustained microperforations to her bowel by the spiral tacks when, due to her obesity, her abdominal wall and tacks caused a postoperative pressure necrosis after the CO2 gas was removed following laparoscopy. The subsequent Defendants claimed that their evaluation efforts in the emergency room were reasonable and timely and, in any event, the Decedent would not have survived anyway due to her age and comorbidities.