This case involves a 49-year-old male patient from Michigan who underwent a vasectomy. Within an hour of the procedure, the patient called about brisk bleeding, but the doctor did not seem concerned and told him to call if the problem persisted. The patient called the doctor multiple times about the significant amount of bleeding and no matter how much pressure was placed, the bleeding would persist. After only 3 hours of being discharged the patient returned to the doctor’s office with excessive bleeding. The surgeon put a stitch in a vessel and told the patient the bleeding would stop soon. However, the bleeding continued and follow up calls did not result in further care. Within 3 days after the stitch was placed, he was sent to the ER by his family physician with a significantly enlarged testicle and extreme pain. It was found that his scrotum was filled with blood, and he later developed an infection in the testicle.
Question(s) For Expert Witness
- 1. How often do you perform this procedure?
- 2. If a patient is bleeding briskly before the procedure ends, is it appropriate to address the bleeding prior to releasing the patient?
- 3. If a stitch in a vessel does not control bleeding, what steps need to be taken?
- 4. Have you ever reviewed a similar case? If so, please explain.
Expert Witness Response E-000493
If an initial stitch does not stop bleeding, you need to go to the operating room, extend the excision and definitively control the bleeding. I have reviewed similar cases two or three times. Invariably, the initial inadequate response by the operating physician leads to such a complication which is avoidable. Bleeding is a risk of any procedure but since the operation seems “minor” in the mind of the physician the response to the complication may be initially inadequate. As in many cases, the real problem is not the complication per se but failure to take remedial action promptly.
Expert Witness Response E-097069
In general, bleeding should not be left unchecked. A stitch is only reasonable if the site of bleeding is on the skin and clearly identifiable. Otherwise the patient should be examined in the operating room or referred to a urologist. I have encountered such cases clinically and serve as the tertiary backup for such complications.