Legal: Bowel perforation during laparoscopy

A 54-year old Pennsylvania woman with chronic pelvic pain and a history of severe endometriosis and adhesions was admitted to a hospital in 2001 with worsening abdominal and pelvic pain. She continued to complain of pain, and 2 months later she went to a gynecologist, who performed a laparoscopy with enterolysis as an outpatient. The next day the patient was admitted to a hospital with complaints of increasing abdominal pain and inability to urinate. She underwent an exploratory laparotomy; three perforation sites were found and repaired. A few days later she had another exploratory laparotomy due to pain, hypoactive bowel sounds, and mild abdominal distention. This operation included complicated small bowel resection, creation of an end ileotomy and drainage of intraabdominal and abdominal wall abscesses. She continued to have fever and sepsis, and a third laparotomy with abdominal washout, irrigation, and debridement of abdominal wall infection and reclosure of the abdomen was performed. A week later she had a period of atrial fibrillation that was treated with IV medications. A EKG cardiac enzymes were negative and abdominal CT the next day showed no evidence of an abscess. She died the following day.

The gynecologist was sued and the claim was that he failed to adequately explain the high-risk nature of the initial procedure and the increased risk to the patient due to her previous surgeries and prior diagnosis. It was alleged that no alternatives were given, that this patient was not a proper candidate for a laparoscopy, and the three perforations of the small bowel occurred during the trocar placement and should have been recognized and repaired at the time.

The physician claimed that bowel injury is a known complication of laparoscopy and is often not diagnosed at the time of surgery and the patient had given informed consent for this procedure. A defense verdict was returned.