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  • Writer's pictureDr. Paul Sinkhorn, M.D.

Ureteral or Bowel Injury at Gynecologic Surgery

The ureter and bowel are vulnerable to injury during gynecologic surgery because of their close proximity to other pelvic organs, including the uterus, tubes, and ovaries.

Bowel and ureteral injuries include contusion, devascularization, laceration, transection, kinking, suture-ligation, mis-application of clips, and electrical or heat burns from electrosurgical instruments.

If a woman has any predisposing factors such as endometriosis, abnormal pelvic anatomy, pelvic adhesions, large ovarian or tubal masses, cancer, or unpredicted intraoperative bleeding, the likelihood of ureteral or bowel injury during gynecologic procedures may increase.

If your client has undergone gynecologic surgery and has suffered a ureteral or bowel injury, OB-GYN expert witness, Dr. Paul Sinkhorn can examine the medical records to determine if there is negligence and causation of damage.

Similarly, if your client is a surgeon who experiences a bowel or ureteral complication during abdominal or pelvic surgery, Dr. Sinkhorn can help determine whether or not negligent technique led to the injury, and can often assist in defense of these cases.

Gynecologic Surgery Injury

When ureteral or bowel injury occurs, the method of repair is determined by various factors, such as location and duration of the injury, timing of diagnosis, specific type of bowel or ureteral injury, and any related illnesses.

The ideal time for repair of the injury is when it initially occurs (during the operation) because that is the time when the tissues are in their best condition and the field of damage has been limited.

Rather than realizing an injury after the fact, immediate recognition and repair lead to better results and fewer long-term complications.

Sometimes, it can be difficult to determine if a bowel or ureteral injury has occurred as a result of a gynecologic procedure, but the most common symptoms are:

● Fever,

● Elevated white blood cell count,

● Constant abdominal discomfort & bloating,

● Kidney (flank) tenderness,

● Blood in the urine,

● Liquid escaping through the vagina,

● Lower abdominal or pelvic mass,

● Oliguria,

● Elevated serum creatinine levels.

Unfortunately, many ureteral or bowel injuries from gynecologic surgeries are found when the damage may have already been done, and after worse complications, such as sepsis, have set in.

This doesn’t mean that repair and management of the injury is impossible but detecting damage after an operation is more difficult, and may require complicated repairs and procedures.

In the worst cases, bowel or ureteral injuries can lead to severe patient morbidity, including an irreversible loss of bowel or renal function, chronic renal failure, colostomy, and/or the loss of a kidney or a portion of bowel.

Whether or not your client’s case is that extreme, patients typically perceive bowel or ureteral injury as inadequate surgical care, which provokes litigation aimed at the hospital, surgeon, or other medical staff.

While the chance of ureteral or bowel injury at gynecologic surgery is typically less than 2%, some studies report the risk of litigation after injury may reach as high as 90%.

OB-GYN Expert Witness

If your client has been involved in a gynecologic procedure wherein a bowel or ureteral injury occurred, you may wish to contact OBGYN expert witness, Dr. Paul Sinkhorn, to get the medical expertise necessary to fully analyze your case.

Dr. Sinkhorn is a board-certified obstetrician/gynecologist with more than 35 years of experience in clinical and academic medicine.

For more information, visit our website.

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