Hysterectomy Bowel Perforation and Fraud Lawsuit

Rana v. Gopalani

Abdominal AnatomyThis OB/GYN malpractice claim was filed in Montgomery County after a physician injured a woman's intestine during a hysterectomy. It was filed in Health Claims Arbitration on January 11, 2018, and it is the 21st medical malpractice case filed in Maryland this year.

Summary of Plaintiff's Allegations

After a woman had been experiencing heavy menstrual bleeding with occasional pelvic pain and pressure for two years, her physician recommended a total abdominal hysterectomy. The doctor kept inadequate documentation of the woman's complaints and symptoms, and the complete removal of her uterus was presented as the only option for treatment.

The doctor noted in her postoperative report that "there were no complications" during surgery, but it was later discovered that she had cut the woman's intestine during the procedure and repaired the injury herself. The woman was never informed about the injury and she was discharged home.

Several days after the surgery, the woman developed severe abdominal pain and distention - classic symptoms of a bowel perforation. The doctor recommended stool softeners, but the woman's pain became worse and she was transported to the Montgomery Medical Center Emergency Department. A CT scan revealed air in her abdomen and fluid in her mesentery (folds attaching the intestine to the abdominal wall). Still, the woman was not informed about her injury.

The woman was kept in the hospital overnight, and the next morning a surgeon told her about the massive infection that had been developing in her abdomen. Because the infection had not been treated for a week following the negligent hysterectomy, it had worsened into ischemic necrosis, intra-abdominal abscess, sepsis, and septic shock. In other words, it had become a life-threatening condition.

While in recovery, the woman developed a bowel obstruction and had to undergo another major abdominal surgery. The physician's assistant who had been present during the hysterectomy confirmed that the intra-operative intestinal cut and suturing were likely the cause of the woman's abdominal infection. The PA was surprised that the doctor hadn't disclosed the bowel injury to the woman and her family.

The woman eventually recovered from the medical errors and she no longer requires a gastrostomy tube. She still suffers from frequent abdominal pain and indigestion.

Additional Comments
  • While a hysterectomy is one possible treatment for abnormal vaginal bleeding, oftentimes vaginal bleeding can be successfully controlled with other treatment methods such as intravenous or oral medications. According to the American College of Obstetricians and Gynecologists' Committee on Gynecologic Practice, vaginal bleeding should only be treated surgically when a patient is not clinically stable and/or has not responded to medical management. A hysterectomy is among the most invasive of the surgical treatment options and it rules out the possibility of future childbearing.

  • A study published in the Journal of Trauma and Acute Care Surgery has shown that small bowel perforations have low rates of mortality and complication if patients are treated within 24 hours of the injury. A bowel perforation allows air and fluids to leak into the abdominal cavity, causing devastating infection if left untreated. Because infection can spread rapidly, time is of the essence when it comes to treating bowel perforations.

  • It is always critical for doctors to thoroughly inform their patients about the full extent of their medical condition, per the well-established standards of care. Doctors are required to tell their patients the whole truth. In this case, the doctor's alleged cover-up was particularly egregious because of the dangerous and time-sensitive complications associated with a bowel perforation. The patient knowing there was a perforation is important if she goes to the emergency room for treatment of complications.

Jurisdiction
  • Montgomery County
Defendants
  • An obstetrician and gynecologist in Olney
  • The doctor's medical practice
Hospitals Where Patient was Treated
  • MedStar Montgomery Medical Center
Negligence
  • Failing to adequately document the woman's symptoms and medical history before the hysterectomy.

  • Failing to provide the woman with less invasive treatment options, such as medication, hysteroscopic resection of polyps, or endometrial ablation.

  • Failing to perform the appropriate pre-operative workups, including hysteroscopy, saline sonography, transvaginal ultrasonography, and endometrial biopsy.

  • Failing to use a careful surgical technique in order to prevent a small bowel injury.

  • Failing to disclose the surgical complication and repair.

  • Discharging the woman while she was developing an intra-abdominal infection.

Specific Counts Pled
  • Negligence: The woman continues to suffer from abdominal pain and indigestion as a result of the surgical error.

  • Loss of consortium: The woman's husband lost his job because he took many days off from work to take care of his wife.

  • Fraud: The doctor intentionally misrepresented the outcome of the hysterectomy.

  • Informed Consent: The doctor did not provide the woman with any alternative treatment options for her abdominal and pelvic pain, and did not properly educate the woman about the risks associated with a hysterectomy.

Plaintiff's Experts and Areas of Specialty
  • Douglas R. Phillips, M.D., Obstetrics and Gynecology
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