General Surgery Expert Discusses Internal Injuries Following Botched Bowel Resection

This case involves an elderly female patient in Massachusetts who presented to the hospital with lower back pain, and subsequently underwent a CT scan and colonoscopy that showed a suspicious mass. The patient presented to the hospital a few days later for bowel resection surgery to treat the mass. Notes from the procedure indicate that the surgery was successful. A few hours after the procedure, however, the patient developed abdominal distention. Tests revealed a severed ureter, as well as acute renal failure. She was treated and sent home, but returned a few days later with multiple complications, including sepsis and a heart attack, and had to be hospitalized. The patient languished in the ICU for several months before dying.

Question(s) For Expert Witness

1.Have you treated a patient that presents with a similar mass?

2.Have you seen a ureteral injury following a colectomy?

Expert Witness Response E-005305

I have treated patients in the past with a similar mass, which I assume in this case was a colorectal cancer. If the cecal mass had been biopsy proven to be a colorectal cancer (whether pre-op or intra-op via frozen section), standard of care would dictate that 5 cm margins are requires and that a formal right hemicolectomy would likely be performed. If the pathology of the cecal mass was unknown at the time of operative exploration, a biopsy with frozen section should have been done to confirm whether or not it was malignant. I have seen ureteral injuries after colon resection as well as other pelvic operations. It is best to try and avoid injury if possible, either by stenting them pre-op or identifying them and protecting them pre-op. If a patient develops worsening abdominal pain soon in the postoperative period, a ureteral injury would have to be a significant concern. Diagnosis could be made via a CT urogram or intravenous pyleogram. If a drain was left, the fluid could be sent for creatinine. If elevated it would be highly suspicious for a ureteral injury. The ideal treatment is primary repair over a stent if the defect is small, or possibly reimplantation into the bladder.