Detailed Treatment Process
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Female, 52 years old The Medical Malpractice Appraisal Committee has confirmed the following course of events in writing. The patient presented to the gynecology outpatient clinic at 9:11 a.m. on January 29 with a history of “menopause for 2 years, requesting intrauterine device removal.” Preoperative examinations were performed. Intrauterine device removal was carried out in the gynecology outpatient clinic at approximately 10:50 a.m. on January 30. At around 11:20 a.m., shortly after the procedure, the patient complained of lower abdominal pain accompanied by vomiting. She was subsequently kept under observation in the abortion operating room. A complete blood count was drawn at 3:15 p.m.; results at 3:21 p.m. showed a white blood cell count of 21.27 × 10⁹/L. At 3:27 p.m., bedside ultrasound revealed 0.2 cm of fluid in the uterine cavity and 2.9 cm of pelvic fluid with pus. The patient reported abdominal pain and distension. Outpatient urethral catheterization was performed, with a good flow of urine obtained. At 4:40 p.m. she was transferred to the ward for further catheterization, but little fluid was obtained. At around 5:20 p.m., the patient was discharged home for observation. At approximately 1:31 a.m. on January 31, she was brought back to the emergency department by her family. The surgical team took a history and, at around 1:50 a.m., consulted internal medicine. On examination the patient was drowsy, blood pressure was unmeasurable, pulse was weak, extremities were cold, and heart rate was 160 beats per minute. Her level of consciousness deteriorated progressively. An electrocardiogram at 2:13 a.m. showed a flat line. She was pronounced dead at 4:17 a.m.
The following is a copy of the ultrasound report. Examination date: January 31 Department: Emergency Department Clinical diagnosis: Vomiting Examination sites: [Uterus and adnexa, transabdominal] [Bedside ultrasound] [Liver, gallbladder, spleen, pancreas, kidneys] [Abdominal fluid] Ultrasound findings: Liver: Normal size and shape, smooth surface, homogeneous parenchyma, clear vessels, no dilatation of portal vein or intrahepatic bile ducts. Color Doppler shows good portal vein flow into the liver (red). Post-cholecystectomy; common bile duct not dilated. Spleen: Normal size and shape, homogeneous echo, no splenic vein dilatation. Pancreas poorly visualized due to bowel gas. Both kidneys: Normal size and shape, clear structure, no pelvicalyceal separation or stones. Color Doppler shows good branching intrarenal blood flow. Free fluid seen around the liver, in the hepatorenal space, and around the spleen, deepest approximately 16 mm, with poor internal echoes. Ultrasound impression: Abdominal fluid collection
Report time: January 31, 04:21:25 (by this time the patient had already died)
The Medical Malpractice Appraisal Committee’s final opinion stated that the hospital committed the following errors:
1. Violation of technical specifications for intrauterine device removal in postmenopausal women. 2. Failure to establish a timely diagnosis and provide appropriate management when the patient developed severe abdominal pain and vomiting half an hour after the procedure. 3. Postoperative uterine and small-bowel perforation resulting in: ① tissue necrosis at the sites of uterine and small-bowel perforation, ② diffuse peritonitis with pelvic abscess and fluid collection, ③ acute pulmonary congestion and edema, ④ cerebral edema.