Case Archive
 
Gynecology
Ref. # 622101

A 44 year-old West Virginia woman presented to her gynecologist with a five-year history of premature menopause and two days of vaginal bleeding. A dilation and curettage (D & C) revealed no pathology and a cervical biopsy was normal. Two weeks later the patient returned with left-sided pain. Her Provera dose was increased from 2.5 mg to 10 mg. An ultrasound revealed a uterus with normal dimensions and a 2.3 cm echogenic focus in the fundus that was consistent with a uterine fibroid according to the records. The vaginal bleeding continued for a month and was recorded as "intractable menorrhagia." A total abdominal hysterectomy and bilateral salpingo-oophorectomy was scheduled. The patient's admitting hemoglobin was 14.8. The surgery was performed. The gynecologist reported only mild pelvic adhesions. Pathology revealed a small uterus with inactive endometrium and normal ovaries; no uterine fibroids were found. Shortly after the surgery the patient developed uncontrollable urinary incontinence. Two weeks later she consulted a urologist, who performed a cystoscopy and diagnosed a vesico-vagina fistula. Three days later the urologist performed an abdominal bladder exploration and repair of the fistula. The patient remained completely incontinent for several months, requiring diapers and eventually psychiatric consultation. Five months after the fistula repair another urologist diagnosed a dense scar at the level of the left ureter: there was a suture around the left ureter and into the urinary bladder. The patient underwent two major laparotomies with left uretolysis, reimplantation of the left ureter and left ureteral stent placement. A medQuest gynecologist reported the patient's care prior to the initial surgery was negligent. The patient's admitting hemoglobin indicated her bleeding must have been mild. The hormonal manipulations the gynecologist attempted were minor and of very short duration. Neither the single ultrasound finding of a possible benign 2.3 cm uterine fibroid nor anything else in the patient's case justified a hysterectomy and salpingo-oophorectomy. The ureteral and bladder injuries constituted negligence as well, as did the failure to check the ureters for adequate peristalsis post-operatively. The gynecologist's negligence increased the patient's morbidity and subjected her to the subsequent procedures.




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