January 7, 2025 from Canadian Lawyer Magazine
A recent decision from the Ontario Superior Court of Justice highlights the critical importance of thorough surgical inspection. In a ruling issued in early 2025, the court found a gynecologist negligent for failing to detect and repair a bowel perforation during laparoscopic surgery—an oversight that led to life-threatening complications for the patient.
The Surgery and Its Aftermath
The plaintiff underwent laparoscopic surgery in 2015 at St. Michael’s Hospital in Toronto to treat a uterine condition. During the procedure, a bowel perforation occurred but went unnoticed. It wasn’t until 36 hours later that the injury was discovered, after the patient developed severe symptoms and required emergency surgery.
The result was weeks in intensive care, a series of follow-up procedures, and long-term consequences including the need for a colostomy. While bowel injuries are a known risk of pelvic surgery, the court found that this particular case involved a breach in the standard of care that could have prevented the worst of the outcome.
What the Court Considered
At the centre of the case was whether the surgeon took appropriate steps to identify any injury during the operation. The court found that the surgeon failed to adequately inspect the surgical area—specifically, the site where adhesions had been removed between the bowel and the fallopian tube. This area, the court noted, should have received special attention given the risks associated with removing adhesions near the bowel.
Expert witnesses from both sides agreed that proper inspection is critical when adhesions are present. The plaintiff’s expert argued that a bowel perforation measuring one to two centimetres should have been visible and detectable. The defence expert also admitted that such an injury would likely have been noticed if appropriate inspection had taken place.
Additional Risk Factors Required More Caution
The court also highlighted several complicating factors in the surgery: the use of a uterine manipulator that perforated the uterine fundus, the patient’s body mass, and the presence of epiploica—fatty tissue on the colon that can obscure visibility. These risk factors, the court said, should have signaled the need for even greater vigilance.
Negligence Led to Preventable Harm
The court concluded that the surgeon’s failure to thoroughly inspect and detect the injury during surgery was a breach of the standard of care and directly caused the patient’s complications. The parties had already agreed on damages, so the trial focused entirely on liability.
This case serves as a reminder that even known surgical risks can lead to liability if precautions aren’t taken. For patients and providers alike, it reinforces the importance of diligence in both surgery and postoperative care.
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