Vol. 8, No. 6, Pg. 14. Foreign Objects: Do They Speak for Themselves.

• Author: By Charles E. Hill

South Carolina Lawyer

1997.

Vol. 8, No. 6, Pg. 14.

Foreign Objects: Do They Speak for Themselves

14FOREIGN OBJECTS: Do They Speak for Themselves?By Charles E. HillThe weary surgeon pushed away from the operating table. It had been a long and difficult procedure. The 75-year old patient had been referred some time earlier with gangrenous changes in her foot. Careful workup had confirmed severe atherosclerotic disease in her abdominal aorta. The best long-term solution was to detour blood flow around the diseased artery by the implantation of an artificial vessel.

The procedure, called an aortobifemoral bypass, involved grafting the synthetic artery to the aorta at the floor of the abdominal cavity, then extending branches of the implant to connect with the femoral arteries in the patient's thighs. Given her underlying heart and lung disease, it was a risky undertaking at best. Now, after five hours of tedious work, it was almost over.

To keep the intestines out of the way while working on the aorta, the surgeon had used a bowel isolation bag, a euphemism for what is no more than a sterile plastic bag with a cinch cord. At the start of the procedure, the bowels were packed into the bag, along with some moist laparotomy pads, and the draw string pulled snug.

Now, with the artificial vessel in place, the surgeon snipped the cord and opened the bag. The intestines tumbled back into the abdominal cavity, and the surgical techs nimbly retrieved the lap pads. The sponge and needle counts were correct, and the surgeon closed without incident.

The patient's post-surgical course was not smooth. She developed pneumonia and had to be put on a respirator. The pulmonary specialist was unable to wean her from the mechanical breathing device. Two months after the surgery, she was still in the hospital and was not improving. She began to exhibit symptoms of a small bowel obstruction. Suspecting adhesions from the operation, the surgeon reluctantly scheduled an exploratory laparotomy.

Shortly into the second procedure, the surgeon was carefully examining loops of intestine when he saw it. There was a stunned silence in the operating room as he removed from the patient's abdomen the cause of the obstruction-the drawstring from the isolation bag.

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The foreign object left behind is the quintessential medical malpractice daim. Cases of inadvertently misplaced sponges, needles, clamps, drains and pads have plagued surgeons for years. (See examples in Annot., 10 A.L.R.3d 9 (1966).)

Carefully choreographed counting rituals have evolved in surgical suites in an effort to prevent such mishaps. But accidents still happen. In the actual case described above, the hospital's evidence demonstrated that some 309 items were accurately counted, times three. But no one anticipated the...