Partial nephrectomy results in bowel injury, lawsuit

Dawn Collins, JDA 71-year-old woman underwent an open partial nephrectomy on her right kidney. During the operation, electrocautery was used. 

Seven days later, the patient presented to the emergency room with abdominal pain. The emergency room physicians spoke to the original surgeon and residents involved with the nephrectomy and learned of the electrocautery use and suspected a bowel injury. The patient then underwent emergency surgery to resect the injured portion of her small bowel.

Related: Extracapsular prostate cancer leads patient to sue

After 5 days, she was discharged only to return 2 days later, suffering from nausea, vomiting, and abdominal pain. She was diagnosed with a partial bowel obstruction and remained hospitalized for 5 days. She had two additional operations within 2 months.

The patient sued those involved with the nephrectomy and alleged negligence in failing to treat the bowel injury during the initial operation. She claimed the physicians knew of the bowel injury at the time, failed to take appropriate steps to treat it, failed to tell the patient’s family about the injury, and did not document the injury in the operative report or any medical records. She argued that because the original injury was not repaired, she subsequently suffered life-threatening injuries.

Click here for the verdict.

The defendants did not dispute these claims but did question the severity and frequency of her complaints and whether they related to the original operation. The jury found for the patient and awarded $1.1 million in total damages, and the judge subsequently awarded $199,000 in interest for a total of nearly $1.3 million.

Failure to perform GU exam results in loss of testicle

A 16-year-old male patient went to the emergency department of a Massachusetts hospital. He complained of severe lower right quadrant abdominal pain and reported experiencing nausea and vomiting. He was given medication for the nausea and was examined. A general surgery consultation, blood work, computed tomography scan, and ultrasound were all negative. He was discharged and sent home.

Also see: Mesh cystocele repair leads to perforated bladder

The following day, the patient returned to the emergency room with right testicular pain. He was taken to the operating room for a scrotal exploration, which resulted in a right orchiectomy.

The patient sued those involved with his first emergency room visit, and alleged that the failure to perform a testicular examination or discuss torsion with a teenaged male patient complaining of lower abdominal pain of unknown origin amounted to a departure from the standard of care. A $300,000 settlement was reached.

Next: Ureter injuries during hysterectomy

Ureter injuries during hysterectomy

In one case, a Virginia woman underwent a total vaginal hysterectomy performed by a gynecologist in 2013. During the procedure, the left ureter was transected and/or fused shut, preventing the flow of urine from the kidney. The injury was not discovered until 8 days later. During that time, there was degradation of the patency of the ureter and intense physical pain. The patient also suffered other complications, including the inability to sleep soundly and the inability to perform many normal daily activities. She sued the gynecologist and the case settled for $350,000 prior to the physician’s deposition.

In a second case, a 40-year-old Illinois woman underwent a total abdominal hysterectomy performed by her gynecologist to treat her uterine fibroids, excessive bleeding, and pelvic pain. She complained of post-op abdominal pain until her discharge home.

Read: Nephrectomy gone wrong leaves patient paraplegic

Two days after discharge, she returned to the emergency room with complaints of continued abdominal pain and urine leakage. The gynecologist referred the patient to a urologist, who diagnosed a stricture of the left ureter with a ureterovaginal fistula, requiring a nephrostomy and subsequent left ureter reimplantation surgery 3 months later.

The woman sued the gynecologist and asserted the left ureter was either crushed or cut at the pelvic brim during the original operation.

The physician argued that the ureter injury was a known complication of the procedure. A defense verdict was returned.

Click here for Ms. Collins' Legal Perspective

LEGAL PERSPECTIVE: While ureteral injury is a known complication of a hysterectomy that can occur in the absence of negligence (and usually patients have signed consents that have addressed this complication), that does not prevent patients who have a ureteral injury from filing a malpractice suit against the caregivers. The usual issues involved are the timely recognition of the complication and the appropriate management.

In these cases, one was successfully defended even though the patient had a second operation for reimplantation. The other case settled even before the physician’s deposition was taken, and while it does not state the reason for the settlement and we do not know the patient’s symptom and complaint history, it may have been problematic that it wasn’t until 8 days post operation that the injury was recognized and treated.

More Malpractice Consult:

Unnecessary kidney surgery proves costly

Failure to report abnormal PSA leads to Gleason 9 PCa

Removal of cancer-free testicle prompts lawsuit

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