Missed bowel perforation leads to complications and a large settlement

A 41-year-old woman with two children presented with a history of heavy painful periods. She had a copper intrauterine device in place and did not want any more children. She owned a successful catering business.

She was seen by a consultant gynaecologist in a private hospital. The gynaecologist discussed different treatment options including the risks and benefits of each option. Arrangements were made for a diagnostic laparoscopy, sterilisation and removal of intrauterine device.

During the laparoscopy the insertion of the lateral port impacted on part of the small bowel, but the bowel did not appear to be perforated. Overnight the woman suffered pain. Her gynaecologist attended and recorded that her abdomen was mildly tender. The gynaecologist prescribed stronger analgesia. The next morning a CT scan was arranged. This was reviewed by the radiologist and gynaecologist who concluded that there were no signs suggesting a bowel perforation. The woman was discharged home later that day.

That night the woman called an ambulance due to worsening pain. She was admitted to her local hospital. The same gynaecologist reviewed her however there was a delay in requesting surgical review. A midline laparotomy was undertaken. The findings were of a perforated small bowel and faecal peritonitis. Following surgery the woman developed sepsis and suffered a pulmonary embolus. She was unable to work for four months.

The case was settled for a large sum because:

• The bowel perforation could have been diagnosed either at the time of laparoscopy or before discharge from hospital.
• If the repair of the bowel had been undertaken sooner the woman would probably not had suffered complications and recovered quicker.
• Part of the settlement covered four months of lost earnings.

This case is based on a real scenario, with some facts altered to preserve confidentiality.