This case involves a 40-year-old woman who presented for an elective laparotomy with lysis of adhesions, enterolysis, and abdominal hysterectomy with bilateral salpingo oophorectomy. During surgery, the Foley catheter was removed because the patient did not pass urine for some time and a cytoscopy was performed. The bladder edges had prominent blood vessels and it was slightly hydrodistended. There was rapid flow from the patient’s left orifice. The right orifice had delayed function and at this point the attention was turned back to the abdominal cavity. The ureter was felt to be kinked under a suture. The suture was released, and there was good flow through the ureter. The surgery was completed without further complication and the patient was discharged. On post-op day 9, patient presented to the ER with complaints of an increase in abdominal pain, fever, and urinary frequency. The patient was diagnosed with right hydroureteronephrosis and acute kidney failure.
Question(s) For Expert Witness
1. Was the care rendered to the kinked ureter within the standard of care?
2. Was any additional testing/follow-up required to determine the delayed function of the right orifice?
Expert Witness Response E-006011
During a hysterectomy procedure, a ureteral dissection is not routinely performed unless concern arises about a potential or actual injury to a ureter. Dissection presents significant risk, since the ureters course under the peritoneum and through a highly vascularized region that can easily be injured, resulting in major bleeding. In this case it seems as if the sutures were placed to stop some bleeding and the surgeon did not realize that the ureters were obstructed until some time later. The patients BUN/Cr should be followed closely after surgery and if it wasn't recognized then after abnormal lab values, that now becomes a failure to diagnose the more complicated issue of acute renal failure.
About the author
Wendy Ketner, M.D.
Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.
Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.
Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.
