During a tubal ligation, patient sustained bowel perforation on December 10. Despite symptoms (abdominal pain, distention) that began the day after the procedure, the perforation was not diagnosed until December 13. By that time, patient had developed severe peritonitis, sepsis, pneumonia, and malnutrition. She subsequently underwent emergency repair on December 16, placement of a central line, thoracentesis, and paracentesis. Pt was ultimately discharged on January 5.
Issue: Was perforation itself negligent? Was failure to diagnose perforation for three days despite abdominal pain and distention negligent?
MEDQUEST EXPERT RESPONSES:
The perforation itself might not be negligent, dependent upon intra-abdominal conditions such as adhesions or endometriosis. Post-op abdominal and distension are normal confounding factors, but the perforation diagnosis seems unduly delayed and was likely negligent. Dr DP – OBGYN
Perforation not negligent, but failure to diagnose it earlier was probably negligent. Dr GS – OBGYN