Case #4058 Medical Negligence
Plaintiff was a 38 year old woman with a medical and surgical history significant for uterine fibroid and ovarian cyst removals, partial bowel resection, cholecystectomy and lysis of adhesions. Plaintiff presented to a local hospital with complaints of abdominal pain. She was diagnosed with recurrent bilateral endometriomas and was instructed to follow up with her ob/gyn for further management.
She subsequently presented to the ob/gyn. It was decided to proceed with a total abdominal hysterectomy and bilateral salpingo-oophorectomy considering the recurrence of the endometriomas despite a year of Lupron therapy. Plaintiff underwent the planned surgery. During the surgery she also required a partial bowel resection and reanastomosis due to bowel perforations.
Plaintiff remained in the hospital for several days postoperatively. Her WBC was slightly elevated throughout her hospitalization, with the last value at 12.56. Her bowel sounds also remained hypoactive. Additionally, Plaintiff’s pain was documented as “poorly controlled throughout her admission.” Finally, postoperative orders noted a “sepsis alert,” indicating that “this patient has signs of sepsis.”
During a postoperative follow-up appointment at the Defendant ob/gyn’s office, Plaintiff complained of pain. No evidence of infection was noted. Keflex was prescribed for potential abdominal wall infection. Days later, an area above the abdominal incision opened. Plaintiff called the Defendant’s office and was instructed to cover the wound with betadine and a dry dressing and return to the office in two days.
When Plaintiff returned to the Defendant’s office, multiple weeping abdominal wounds were noted and Plaintiff was admitted to the hospital for further management. On presentment to the hospital, a CT scan of the abdomen and pelvis was performed. The scan showed air tracking within the soft tissues, as well as some denser material which may represent contrast. There was also a small amount of pelvic free fluid. Radiology recommended close monitoring to exclude an evolving process.
Debridement of the abdominal wall ulcer was eventually performed. An intraabdominal wound vac was applied as closure. Plaintiff was ultimately transferred to that tertiary care facility for further wound management.
Upon admission, the wound vac was removed and a large amount of purulent and feculent drainage was noted, and the abdomen was completely opened. Therefore, she was taken to the operating room for urgent exploration of the abdomen. During this exploratory surgery she was noted to have an area of small bowel that was perforated, very edematous and with many serosal tears requiring approximately 90cm of small bowel to be resected. The fascia was closed and the skin left open with wound vac placement. Plaintiff was taken back to surgery for planned delayed closure of her abdominal wound. A colotomy was discovered at the junction of the sigmoid colon and rectum at the pelvic brim, requiring an omental patch and a diverting colostomy. Another enterotomy was also discovered in the colon. She was started on Vancomycin and Zosyn initially, and after an infectious disease consultation, Cipro and Flagyl were also added.
Plaintiff was ultimately discharged home with a wound vac and colostomy. The wound vac was eventually taken down. Reversal of the colostomy was eventually performed. She had two (2) fistulas develop after the reversal requiring her to be placed on TPN. She continues to require frequent hospitalizations since discontinuation of TPN due to abdominal and gastrointestinal issues.