Page 43 - Avoiding Surgical Mishaps Part 1

SVMIC Avoiding Surgical Mishaps: Dissecting the Risks

CASE STUDY

A 74-year-old female with a history of diverticulitis and
previous abdominal surgeries presented to our insured

general surgeon with complaints of abdominal pain and

cramping. A hiatal hernia was found and, after a period
of conservative treatment, the patient opted for surgical
repair. During the consent discussion, the physician outlined

the most common and most severe potential risks with

her, including risks specific to laparoscopic surgery. This
discussion was documented in the medical record.

A laparoscopic hernia repair was performed on January
6 and required the surgeon to free up multiple adhesions

between the bowel and the abdominal wall, which was
accomplished without noted complications.

While in the Post-Anesthesia Care Unit, the patient

complained of significant pain, and the surgeon admitted
her to observe for possible complications. Admission orders
included IV Demerol or Zofran as needed for pain or nausea,

along with oral pain medicine once the nausea subsided.

Orders for ambulation in the halls and a clear liquid diet were
also included.

That night, the staff noted an increase in the patient’s
pain, increased pulse rate, absence of urine output, and a

firm, warm bruised area on the right side of the abdomen,
causing the physician to order an abdominal CT scan and

a hemoglobin and hematocrit (H & H) to rule out a possible
bleed. The H & H was normal, and the surgeon felt that the

abdominal pain and bruising could be the result of oozing
from the trocar site into the abdominal wall.

continued on following page

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