A 52-year-old insurance executive with a physically active lifestyle and a 20-year history of hypertension that was difficult to control was referred to a surgeon, after a CT scan revealed a right adrenal mass (~4 cm). The surgeon recommended a laparoscopic adrenalectomy to remove the mass. The patient recalled that he was advised that laparoscopic surgery was less invasive and the recovery “would be quicker.” The consent form that he signed indicated that he was also told that on rare occasions it might not be possible to do this procedure laparoscopically, and a slightly larger incision would be required, necessitating a longer hospital stay.
During surgery significant bleeding developed. It looked like the bleeding was coming from the vena cava. The operation was converted to an open procedure, and the surgeon called for assistance from another attending surgeon. According to the operative report, the adrenal mass was fairly large (>4 cm) and was located “in the very superior position underneath the liver and medially underneath the vena cava – very difficult location.” The bleeding was controlled, and the dissection of the right adrenal mass was accomplished without further complication. The patient received three units of blood. The surgeon did not see the injury occur, but thought it was due to a small avulsion injury or the blocking off of a small tributary.
In the recovery room, the patient’s wife recalled the surgeon telling her that “we hit the vena cava, and there was a lot of bleeding.” She remembered that the surgeon’s scrubs were covered in blood. After their conversation, she went home and looked up ‘vena cava’ on the Internet.
The patient woke up the next day in the intensive care unit on a respirator. He asked his nurse what happened, since this was not what he expected. She told him that there was an emergency in the operating room and that he would have to speak with his surgeon.
After recovery in the intensive care unit and on the surgical floor, the patient went home eight days after surgery. The record reflects one postoperative visit by the attending surgeon, with the notation for the patient to “call if any problems.” The patient and his wife felt that the surgeon was not forthcoming with an explanation of what happened and seemed indifferent to the impact on his patient.