Hernia Repair Leads to Bowel Injury, Unrecognized Sepsis & Death

Gerald Michael Oginski

Case Conclusion Date:November 28, 2012

Practice Area:Medical Malpractice

Outcome:$840,000

Description:It was supposed to be a “simple” hernia repair. The doctor said he had done these many times before. The only difference was that this doctor was a GYN oncologist and not a general surgeon. The patient even asked the doctor whether they should have this done with a general surgeon. The doctor reassured them that he could do this procedure and in fact would look around and make sure she was cancer free during surgery. Three years earlier the patient had been diagnosed with ovarian cancer and had a total hysterectomy. She was then closely monitored over the next three years and at the time of this hernia surgery was cancer free. The patient agreed to have surgery with the GYN oncologist. He was reassuring. He was trusting. She had no reason to disbelieve him. During surgery, something happened. The patient had significant scar tissue, known as adhesions. During the course of the hernia repair, a hole was accidentally made in the patient's bowel. Luckily for the patient, the doctor recognized this hole at the time they made it. The problem was that the surgical team now was faced with a few different options. When a minor injury occurs to the bowel during surgery, the doctors can sometimes oversew it. When the injury is significant and is a through-and-through perforation, it becomes necessary to remove the damaged bowel. However, the better practice is to call in a general surgeon or a bowel surgeon, also known as a colorectal surgeon to fix the bowel injury. In this caes, the surgical team decided they would fix it themselves. That was mistake number two. In order to remove the damaged portion of the bowel, they must cut both sides of the damaged bowel and remove that section of the bowel. They must then take both remaining ends and put them together and sew it tight so it forms a closed seal. That is known as an end-to-end anastomosis. Over the next few days the patient continued to deteriorate. She developed cardiac complications that medication was not able to control. She was soon transferred to another local hospital where they had better cardiac facilities to monitor her condition. Unfortunately, her blood pressure was dropping, her kidney function was dropping and she developed an overall septic picture that required surgical consultation. The surgeon was unable to determine exactly what was going on with her and decided he had to rush the patient into surgery and re-explore her belly to see if there was a possible leak that could be causing her worsening condition. What the surgeon found was remarkable. As he opened up the patient's belly, he saw fecal contents in the belly. This is not something that should be in the belly. These fecal contents are also known as enteric contents. His next observation was startling. The anastomosis, which represents the two ends of the bowel that had been stitched closed together, was wide open. Contents from the bowel had been freely flowing into the patient's belly over the past few days. No one had recognized this was happening. The surgeon attempted to clean the patient out but was unable to close the wound or the bowel. He knew that within a few short hours he would have to clean the patient out again. Over the next few hours, the patient coded three times during the night and ultimately died during her final cardiac arrest. It was our claim that this patient never should have had surgery with the GYN oncologist for an elective hernia repair. Especially when she had no internal female reproductive organs, and this GYN oncologist had never operated on this patient for any GYN cancer problem. Instead, we argued that the patient should have been sent to a general surgeon to have this procedure done. The next mistake was that the surgical team failed to call in a general surgeon or a colorectal surgeon to fix the bowel injury when it happened. Mistake number three was performing the end to end anastomosis in a technically deficient manner so that it opened within 24-48 hours after the original surgery.