Defense Verdict Obtained in Bowel Perforation Case

Dustin J. Denning successfully defended our client, an obstetrician/gynecologist (OBGYN), in a medical malpractice jury trial in which the plaintiff alleged that our client was negligent when performing a laparoscopic assisted vaginal hysterectomy (“LAVH”) during which her small bowel was perforated through and through with a 5 mm optical trocar. The perforation occurred during the initial introduction of the optical trocar into the abdomen, but was not observed intraoperatively during the nearly 2-hour surgery. As compared to traditional trocars that involve the “blind” insertion of a Veress needle and bladed trocar, the plaintiff argued that the optical method is arguably a safer method of obtaining access into the abdominal cavity because the surgeon should be able to visualize each layer of tissue as the tip of the trocar is advanced into the abdominal cavity. The plaintiff alleged at trial that our client deviated from the standard of care in failing to recognize the bowel perforation at the time it occurred and failing to recognize it during the surgery prior to closing up plaintiff.

The plaintiff began showing signs consistent with a post-operative ileus the day after surgery (Post-Op Day 1), and her condition continued to worsen until she was returned to the operating room the morning of Post-Op Day 2 for exploratory surgery that revealed the through and through small bowel perforation. The plaintiff developed sepsis and other significant complications following the second surgery but recovered and was discharged from the hospital 35 days later. The plaintiff sought approximately $870,000 at trial.

We defended the case by showing that while our client preferred the optical port because he felt it was a safer alternative to the “blind” approach, the optical port is still not without risks, including injury to the bowel, and that such a complication occurred absent negligence on the part of our client. We demonstrated that the layers of tissue through which the optical trocar passes can be distorted for various reasons, including the patient’s body habitus, and that failing to observe the perforation intraoperatively is not a deviation from the standard of care. Medical literature suggests that perforations go unrecognized at the time of surgery in 30-50% of all cases.

After a four-day jury trial, a Riley County, Kansas, jury agreed and returned a verdict in favor of our client after deliberating about 45 minutes.