Colostomy Gone Bad? What Could Be Worse

A Delaware man has filed suit against doctors, claiming a horrific surgical mix-up left him urinating feces and discharging urine from his bowels.

According to a lawsuit filed in the Superior Court of Delaware Nov. 1, Joseph E. Swain of Dover, Del., had an operation at Kent General Hospital Feb. 22, 2006, intended to reverse a colostomy -- a procedure that shunts fecal matter away from the rectum and into a bag attached to the patient's body.

A colostomy is often used as a temporary measure to allow patients to recover after certain colon surgeries or injuries. Reattaching the colon to the rectum should have returned Swain's bowel function back to normal.

But the lawsuit states that doctors botched the job by stapling Swain's colon to his bladder instead of the rectal stump -- and that this mistake caused the patient to experience diarrhea, as well as "passing gas and liquid stool from the penis."

He has since had follow-up surgeries to correct the problem.

In addition to the potential for infection, the lawsuit alleges that the man suffered severe pain and suffering, disfigurement and embarrassment, and adds that the episode has also "affected the companionship with his wife."

The case was first reported in The News Journal, based in Wilmington, Del.

"I don't think there's any question that the reversal of the colostomy when this occurred caused the problem," said Gilbert Shelsby, the Dover attorney representing Swain in the lawsuit.

"It strikes you, and you think, 'How in the world can this happen?' You think, 'Can it really be true?'"

The attorney representing doctors involved in the case maintains that the complication was not a result of medical error, but just an unfortunate consequence of the colostomy reversal.

"My clients obviously feel very badly for the medical complications that happened to Mr. Swain," said Jeff Austin, the Wilmington attorney representing Dr. Thomas Barnett and Dr. Barton Clements, as well as Surgical Associates, PA, the practice with whom the doctors are affiliated.

"However, we feel very strongly that they did not bring about these unfortunate medical complications … Because this case is in litigation, it would be inappropriate for me to make any further comments at this time."

The other doctor named in the lawsuit, Dr. Brandt Feuerstein, is no longer associated with Surgical Associates, though he was at the time of the Swain's operations. Officials at Kent General Hospital, where the procedure was performed, did not respond to requests for comment on the case. Bayhealth Medical Center Inc., which runs Kent General Hospital, is also named as a defendant in the suit.

Lawsuit Claims Chain of Surgeries

According to the lawsuit, Swain was first admitted to Kent General Hospital Oct. 19, 2005, as a result of abdominal pain. Doctors found an abscess in his abdomen, which one of the doctors drained through a surgical procedure Oct. 31.

When the pain continued, Swain went back to the hospital Nov. 11. It was during this visit that doctors diagnosed him with diverticulitis -- a condition in which a hole forms in the side of the colon. As part of the treatment for the condition, the doctors removed part of Swain's colon and performed the colostomy.

But the lawsuit states that during the procedure to reverse to colostomy, Barnett and Clements improperly stapled the colon to the bladder, leading to nearly two weeks of agony for Swain.

The man then sought the services of Christiana Hospital in Newark, Del., where he received several surgeries to correct the problem, according to the lawsuit. Doctors at Christiana declined comment on the case.

Dr. Christine Ren, associate professor of surgery at the New York University School of Medicine, said that though surgical errors that would result in these symptoms are rare, they are not unheard of.

"I'm sure this has happened in the past," she said.

She said there are a number of factors inherent to this type of surgery that could have led doctors to make a mistake like the one alleged in the lawsuit. Among these, she said, are the number and position of the structures in the lower abdomen. She adds that obesity or prior scarring within the abdomen can also make technically challenging colostomy reversal surgeries even more difficult.

But she adds that it's difficult to say for certain whether the surgery was to blame, as the lawsuit alleges.

"He may have had this complication even before the colostomy was performed," she said.

For instance, she said, some patients suffering from diverticulitis naturally experience a leakage of fecal matter into the bladder and urinary tract.

"That's been known to happen without surgery," she said. "But if this did happen secondary to an operation, then it really shouldn't have happened, and it is very rare."

Regardless of the cause, she said that any instance in which fecal matter is rerouted through the bladder is a dangerous situation -- particularly when it comes to infection.

"Because feces has a tremendous amount of bacteria and urine is sterile, then the individual would most likely have infection in his bladder, and possibly even his kidneys," she said.

Path to Recovery

Shelsby said the health of his client has improved, but adds that the complications the man experienced, as well as multiple surgeries following the reversal procedure, have left him in a weakened state.

"The time period when this was going on took a great deal out of him," Shelsby said.

Thus far, the exact amount of damages that could be awarded if the suit is successful has not been determined.

"Ultimately the jury will have to decide what the value is," Shelsby said.