12 Hour Delay in Bowel Perforation Diagnosis, Patient Becomes Septic

This case involves a woman who underwent an outpatient hysteroscopic myomectomy for the resection of uterine fibroids. She was discharged home but had an episode of intense abdominal pain that prompted her to return to the ER. A CT of the abdomen revealed free air and fluid, and reports of surgical clips but the surgical note clearly states that no clips were used in the myomectomy. It is believed that the metal came from the loop tool used during the myomectomy and that physicians failed to recognize that material was left behind. It was a full 12 hours before the patient was worked up and given a diagnosis of bowel perforation which led to a severe systemic infection. The complications of this were that the patient became severely septic and was hospitalized for approximately 30 days.

Question(s) For Expert Witness

1. Do you believe that the delay in the work-up caused the patient to deteriorate so rapidly?

Expert Witness Response E-000189

As you are correctly asking, the essence of the case is whether or not 12 hours made the difference. I believe yes, it did; it doesn't take long for a patient with this condition to become septic if they are not handled properly right away. I would like to know the exact time-frame and the initial condition of the patient. I do a lot of GI-related procedures in my practice, and would be interested in reviewing this case.