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64-year-old woman dies from bowel perforation following elective surgery to remove ovary
On Friday, 02/13/04, the plaintiff’s decedent underwent an elective procedure to remove a mass from one of her ovaries. The patient was discharged to home at approximately 7:50 p.m. on 02/13/04 with a prescription for Tylenol #3. The patient used the Tylenol #3 overnight and was still in significant pain in the morning (now Saturday, 02/14/04). She called the OB/GYN’s office and spoke with the covering gynecologist. He suggested that the pain was from constipation and recommended Advil, Milk of Magnesia and Pericolace. He also called in a prescription for Vicodin.
That afternoon, an ambulance took the patient back to the hospital. She arrived at the ER at approximately 3:00 p.m. A nurse noted that she had had diffuse abdominal pain for 12 hours, that she was diffusely tender to palpation, distended and that she thought that she might be constipated. The ER doctor consulted a resident on the OB/GYN service. An abdominal x-ray was done and showed free air under the right diaphragm. Although it is not uncommon to find free air following laparoscopic surgery, free air is also found when the bowel has perforated. Given the unusual level of the patient’s pain and the history of surgical removal of adhesions involving the bowel during surgery, the plaintiff contended it was incumbent on the treating physicians to rule out a perforated bowel.
The resident consulted with the covering attending, and it was concluded that the problem was constipation. At 7:00 p.m., the patient was discharged to home with instructions to take Magnesium Citrate, an effervescent laxative. Given the risk of a perforated bowel, the plaintiff contended this treatment was contraindicated.
The patient took the Magnesium Citrate as instructed and spent a very uncomfortable night without having a bowel movement. The next morning, Sunday, 02/15/04, the patient was still in pain. The OB/GYN instructed the patient to take phosphosoda, another effervescent laxative. After taking the laxative, the patient was in even more pain, and returned to the ER at 3:49 p.m. on 2/15/04.
An abdominal x-ray showed an increase in the air in the abdomen and findings consistent with intraperitoneal free fluid, a question of an ileus and a question of an incomplete small bowel obstruction. These findings were consistent with a bowel perforation requiring surgical repair.
During general anesthesia induction, the patient vomited and aspirated gastric contents. A large amount of fluid was suctioned from the back of her mouth. After intubation, a naso-gastric tube was placed and two liters of fluid were suctioned from the patient’s stomach. On opening the abdomen, the surgeon noted a large amount of bowel contents in the abdominal cavity. He noted that a piece of bowel was stuck to the pelvis – perhaps to the vaginal cuff. He dissected it free, brought it up into the wound and detected a “fair sized rent” on the antimesenteric surface.
The patient deteriorated after surgery, and died on 02/18/04. Post mortem examination concluded that death was the result of sepsis and aspiration pneumonia.
The plaintiff claimed that the defendants were negligent when they failed to recognize and appreciate the signs and symptoms of a bowel perforation, when they failed to arrange for a surgical evaluation when the x-ray revealed the presence of free air in the abdomen, and when they prescribed laxatives.
The defendants denied that they were negligent and contended that their treatment of the patient met the standard of care. The patient had no nausea or vomiting to suggest a perforation, and the presence of free air is expected after laproscopic surgery, and is not life threatening. As such, it was appropriate to believe the patient was constipated and to treat accordingly. The patient’s demise and death was an unfortunate medical result that could not have been predicted or anticipated under the circumstances.
Lubin & Meyer attorneys represented the plaintiff in this medical malpractice lawsuit.
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