This case involved a female patient who had a 5 cm cyst on her right ovary. She underwent surgery for removal of the cyst with possible oophorectomy. During the operation, her surgeon encountered dense adhesions throughout her abdomen. Extensive adhesiolysis was carried out in order to better visualize the pelvic structures. Despite this, neither the cystic mass nor ovaries could be found. The defendant surgeon was called in for a consult and performed a manual palpation of the lower abdomen and pelvic structures, but he too could not find any abnormal masses. At this point, the procedure was terminated. Post-operatively, foul-smelling drainage was noted coming from the incision site and the patient’s condition declined. She was taken back into surgery where the defendant performed an exploratory laparotomy, encountering dense adhesions and inflamed bowel throughout the lower abdomen. Tissue planes were very difficult to discern. Stool was seen throughout the surgical field and 2 large enterotomies were noted in the terminal ileum. About 2 feet of affected bowel was resected and a temporary ileostomy created. The next day, more feculent drainage was seen oozing from the incision and yet another exploratory laparotomy revealed a large enterotomy in the small bowel. which was repaired directly with sutures. Over the next several days, tedious wound care protocols were followed yet the patient continued to spring leaks in her bowel, which required 2 more surgical repairs.
The plaintiff claims the defendant negligently managed the patient’s condition, resulting in an extended hospital stay and multiple surgeries. The defense contended this patient had a propensity for developing adhesions and a very reactive bowel. Due to underlying bowel fragility and type II diabetes, wound healing was compromised and necessary procedures to treat bowel perforations resulted in more perforations opening up post-operatively thus requiring several repair surgeries. Ultimately, the patient’s overall poor bowel condition was responsible for the multiple perforations and need for additional surgeries.