NAD on cystoscopy

A ureteric injury was not detected at the time of surgery

A consultant gynaecologist saw a 49-year old patient who had been referred with a history of dysfunctional uterine bleeding and abdominal pain thought to be due to a complex ovarian cyst. Following assessment and further investigation, the patient underwent hysterectomy and bilateral salpingo-oophorectomy. The consultant planned to perform the operation laparoscopically.

The surgery initially proceeded as expected, but the gynaecologist encountered complications when the patient started bleeding from the uterine pedicle. Further steps were taken and haemostasis was achieved. Due to the treatment required to stop the bleeding the consultant had some concerns that damage may have occurred to the patient's ureter and therefore performed a cystoscopy. She found nothing abnormal.

The patient appeared to progress well and was discharged from hospital three days later. However, she was subsequently readmitted with abdominal pain and vomiting. On assessment she was found to have right hydronephrosis and damage to the ureter on that side. The patient was subsequently treated with a stent and then re-implantation surgery.

The patient brought a claim against the consultant alleging that it was negligent not to have detected the ureteric injury at the time of surgery.

The MDU instructed an independent gynaecology expert who advised that although it may not in itself be negligent to cause damage to the ureter during the surgery, it would be difficult to defend the claim, in view of the delay in detecting the damage and the interpretation of the cystoscopy as normal.

The MDU therefore offered to settle the claim but with no admission of liability. The claimant accepted £8,000 damages, while her costs amounted to four times that figure.

Dr Louise Smy
Senior medical claims handler

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