A pierced bladder during surgery is a recognised complication of some abdominal and pelvic procedures, but it is not automatically medical negligence.
A claim may arise where the injury should have been avoided, was not recognised when it occurred, or where signs were not investigated promptly.
Coleman Legal LLP can review the operation records and subsequent care to establish whether there may be grounds for a claim.
How a bladder injury can happen
The bladder lies close to structures involved in many pelvic and abdominal operations.
It can be injured during hysterectomy, caesarean section and bowel or other pelvic surgery.
Previous operations, scar tissue or adhesions can make the anatomy harder to identify and may increase the risk.
A bladder injury may occur through a cut or puncture, thermal injury from surgical equipment or damage while separating tissues.
Early recognition is important because many injuries can be repaired during the original procedure.
Why a pierced bladder during surgery is not always negligence
The fact that a bladder injury occurred does not, on its own, establish negligence.
Some injuries can happen despite reasonable care, particularly during technically difficult procedures.
The question is whether the treatment fell below the standard reasonably expected in the circumstances.
This may involve considering whether the surgeon identified the bladder, took account of known risk factors and used an appropriate surgical technique.
A separate issue arises if the injury was recognised but not adequately repaired, or if it was missed entirely. Post-operative care may therefore be as important as what happened during the operation.
Delay in recognising a bladder injury
A bladder injury that is not recognised during surgery may become apparent afterwards.
Possible signs include blood in the urine, abdominal pain or swelling, difficulty passing urine, reduced urine output, urinary leakage or a rise in serum creatinine.
More serious cases can involve peritonitis or sepsis.
Where an iatrogenic bladder injury is suspected after surgery, further investigation may be required.
Depending on the circumstances, this can include CT cystography or other imaging to identify whether urine is leaking. A delay does not automatically amount to negligence.
The issue is whether the symptoms should reasonably have prompted investigation sooner and whether earlier diagnosis would have avoided additional harm.
What a claim involves
Medical records are central to investigating the claim.
These may include the operation note, consent documentation, nursing records, catheter and fluid-balance records, blood results, imaging and notes from any later repair.
An independent medical expert, often from a surgical, urological or gynaecological specialty, can assess whether the care met an acceptable standard and whether any failure caused additional injury.
Losses may include further surgery, a longer hospital stay, infection, pain, recovery time, time away from work and other financial losses.
Time limits
In Ireland, a medical negligence action is generally subject to a two-year limitation period from the date the cause of action accrued or the injured person’s date of knowledge, whichever is later.
Date of knowledge concerns when the person knew, or could reasonably have been expected to know, the important facts linking the injury to the treatment received.
Where the injured patient is a child, the limitation period generally does not begin to run until the child reaches 18.
Medical negligence claims arising from surgical treatment are excluded from the Injuries Resolution Board process and are pursued through the courts.
