Background to the Clinical Negligence Case: Ureter Damage by Diathermy
LD was 47 when she consulted Mr K about heavy painful periods. A diagnosis of multiple fibroids was made and after considering the options she elected to have a total abdominal hysterectomy and removal of the ovaries. During examination she was also found to have some ulceration in the upper part (vault) of the vagina. During the operation the bladder was found to be adherent to the front of the cervix and during dissection it was damaged. Mr S, a consultant urologist, was called to repair the bladder. In order to remove the ulcerated area from the top of the vagina, Mr K then made a V-shaped incision to the posterior vault and removed a ‘cuff’ of vaginal tissue. He then inserted several sutures to prevent any bleeding.
Post-operatively LD was generally unwell and a renal ultrasound revealed bilateral hydronephrosis (a backflow of urine into the kidneys). Nephrostomy tubes were inserted to drain the kidneys. Six days later, following further investigations, it was discovered that, although the left ureter was now functioning normally, the right one was severely obstructed. Mr S attempted, via cystoscopy, to insert a stent to dilate the narrowed tube but this was unsuccessful.
A suture on the right side of the bladder wall involving the ureteric orifice was discovered but was impossible to remove. An abdominal incision was made and the ureter reimplanted into the bladder wall with a stent to avoid further obstruction. The stent was removed 2 months later.
LD remained in hospital for 3 weeks longer than anticipated and made a slow recovery. She developed an incisional hernia that caused pain and discomfort and prevented her from seeking employment or resuming her domestic and leisure activities in full. She underwent repair of the hernia 6 months later. The claimant alleged that it was during the removal of the ulcerated area from the vaginal vault that the right ureteric orifice was occluded by a suture. Because of the proximity of the ureters to the upper vagina it is considered unsafe to excise a ‘cuff’ of vagina before first exposing the ureters right down to the bladder. It was alleged that Mr K failed to do this and he therefore performed the operation negligently.
The defendant admitted liability and made an offer of £15,000. Following further negotiations a settlement was reached in the sum of £25,000.
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