Gynecologic Surgery Leads to Sepsis and Death

Case Overview

This case involves an 80 year old female patient with past medical history of hypertension, Crohn’s disease, cystocele, rectocele, vaginal vault prolapse and stress incontinence. She underwent a transvaginal, posterior repair with tension free vaginal tape and adhesiolysis. The operative notes state that there were significant intraabdominal adhesions between the small intestine and the anterior abdominal wall, and the small intestine and pelvic structures. On post-op day 2 the patient developed nausea and vomiting as well as fever. She soon became tachycardic, tachypneic and her Os sats dropped to the lower 90s. She was transferred to the ICU where she received IV fluids and Zosyn. CT of abdomen revealed subcutaneous emphysema along her abdominal wall extending from the symphysis pubis bilaterally. Additionally, there was fluid in the pelvis as well as free air around the bladder and bilateral atelectasis of the lower lobes. IV vancomycin was started. At 3 days post-op, a colonic injury was recognized and the patient was returned to the OR for celiotomy. Operative notes indicate perforation, iatrogenic, of small bowel with contamination of the intra-abdominal cavity with succus entericus. Following drainage and resection of part of the small intestine, she appeared to be improving. On post-op day 6 it was noted that there was bilious drainage from the chordal confines of the surgical wound. She was returned to the OR. Post op diagnosis was bile/bowel peritonitis with leaking bowel. There was re-exploration the following day and further drainage and washout was performed. The patient ultimately expired due to sepsis on post-op day 30 following a prolonged hospital stay.