Patient loses lawsuit against gynaecologist over bladder injury during surgery

A teacher who suffered a bladder perforation during surgery to remove cystic masses and her right ovary has lost a lawsuit against the gynaecologist who operated on her in the Western Cape. 

The woman, who cannot be named for medical reasons, detailed the pain she endured after the operation and went to lengths to demonstrate the specialist gynaecologist and obstetrician’s alleged negligence. But the high court in Cape Town has ruled that the “perforation ... can occur in the best of hands”.

The gynaecologist operated on the woman in April 2016, and her bladder perforation was surgically repaired less than a month later. She claimed the gynaecologist had failed to properly identify organs before separating them from her bowel and did not take enough care to avoid damaging her bladder while using a surgical tool known as a LigaSure Maryland.

She argued the gynaecologist had “failed to appreciate” the tool could cause undetectable damage, leading to tissue death and leakage into her abdominal cavity. 

Seven witnesses testified in the case. The patient called four, including two medical experts, while the gynaecologist called three. 

The patient testified that when she consulted the gynaecologist, she was employed as a teacher.

“In her evidence, the [patient] confirmed the details of her medical history as recorded by the defendant,” the judgment reads. 

“The [gynaecologist] informed her that she had cysts on both ovaries which would have to be removed and sent for histological analysis. As she only had a limited amount of leave, she elected to have the procedure done in April so she could recuperate during the school holiday.

“After the operation, the [gynaecologist] did not come to examine or speak to her while she was in the ward, and did not inform her what he had ‘found out’ during the operation. He also did not phone her to find out how she was doing while she was recuperating at home,” the patient said in her evidence.

However, less than a month after the procedure she collapsed while teaching and was taken to hospital by ambulance. She said a doctor told her that “an ultrasound had revealed the presence of fluid in her abdomen, and he needed to assess what was causing it”.

She was booked in for a laparoscopy the next morning. The woman said “while she was lying on the trolley outside the theatre the [gynaecologist] arrived”. 

“She told him that she did not want him there, and he left. While she was recuperating in the ward, after the operation, the [gynaecologist] came to her and told that he was sorry, as he might have injured her bladder during the operation he performed on her,” the judgment reads. 

During cross-examination, she was shown hospital records contradicting her claim. The records showed she reported severe pain on the morning of her admission, saying it had started the night before. She insisted, however, that she had felt unwell and in pain since being discharged after the initial procedure, with the pain worsening over time.

She was also told that, contrary to her claim, the gynaecologist had seen and spoken to her in hospital before she was discharged. He had checked the medical records, seen that she had passed urine and approved her discharge. She then admitted this might have happened but still denied that he had called her a few days later while she was recovering at home. 

Her husband testified that while waiting outside the theatre after she was admitted the second time, the gynaecologist took him to his consulting room. There, he explained the surgery had been difficult due to heavy adhesions (scar tissue between tissues or organs inside the body), admitted he might have damaged her bladder, and apologised. 

Judge Mark Sher ruled that the patient had ultimately failed to prove that the gynaecologist was negligent.

“In my view, the perforation to the bladder was an unfortunate complication, of the kind which, as the [gynaecologist’s] experts explained, can occur in the best of hands,” read the judgment. “The action is dismissed.” 

The woman was ordered to pay part of the legal costs.