Legal: Ureter injury during ovary removal

A 67-year-old Kentucky woman was diagnosed with multiple cysts on her ovaries during an MRI for back pain. She was told by her family physician that the ovaries needed to be removed and was referred to a gynecologist. A laparoscopic bilateral salpingo-oophorectomy was done in 2007. Because of nausea, vomiting, and pain the patient was kept at the hospital for 2 days before being discharged. Two days later she came back to the emergency room with pain, nausea, vomiting, abdominal distention, and an inability to urinate. A physical exam and an abdominal series of x-rays were performed that suggested some lung problems, but were negative for abdominal findings. The gynecologist saw the patient after the emergency room assessment and admitted her to the hospital. Over the next 5 days the diagnosis of ileus was made as well as probable pulmonary embolus, which was subsequently confirmed by radiology. She failed to improve and a CT scan showed a large amount of fluid in her abdomen; the report recommended a surgical consult. A general surgeon was called and an exploratory laparotomy performed, which revealed 2,800 mL of urine-like fluid in the abdomen. The surgeon suspected a leak but could not find the source. The patient still did not improve and underwent another operation with the gynecologist assisting. She was treated for infection, and underwent several more bowel surgeries. Several months later, an intravenous pyelogram (IVP) test was performed by a different doctor, and blockage was discovered in the right ureter. She had procedures for ureter repair and ultimately ureter replacement.

The woman sued the gynecologist and alleged negligence in failing to immediately order a urology consult, an IVP exam, a CT, or MRI. She also claimed negligence in performing the original procedure in that he was inadequately trained with the harmonic scalpel. She maintained that the ureter leak was detectable immediately after surgery and that an operation done when she returned to the hospital the first time would have found the leak.

The gynecologist claimed that the ureter was not injured in the initial operation, that it was reasonable to rely on the abdominal series x-rays that showed no fluid, and that it was reasonable to rely on consultations by the family physician and two general surgeons, none of whom believed there was a urine leak. He maintained that the ovary was adhered to the ureter, which caused devascularization of the ureter over a period of days, resulting in the leak. A defense verdict was returned.