Forceps in abdomen: Alappuzha woman underwent surgeries in 2007 & 2021, panel probes records of both procedures

The expert committee probing the incident of surgical forceps left in the abdomen of a 51-year-old woman named Usha Joseph has found out that she had undergone two surgeries at the Government Medical College, Alappuzha, one in 2007 and another in 2021. This has prompted the panel to ascertain the timeline and track the medical staff involved in both the surgical procedures. 

According to Usha, she began to experience severe pain and the condition of hematuria (presence of blood in the urine) after she had been subjected to hysterectomy to remove a tumor in her uterus in 2021. Initial allegations of lapses revolved around the medical team associated with the surgery done five years ago. Usha had consulted former Professor and Head of Obstetrics and Gynaecology, GMC, Alappuzha when the tumor was confirmed in 2021.

Medical records scrutinised by the panel showed that in 2007, Usha underwent another surgery to remove an ovarian cyst in the same hospital. Sources in the health department said that the event of retained surgical item (RIS) may have happened either in 2007 or 2021. 

Usha, currently admitted to a private hospital will undergo a surgery to remove the curved artery forceps in her abdomen. The panel will collect the forceps and send it for an examination to find out date of purchase and supply. 

According to sources, Usha underwent surgery in May 2021 when the state was hit by the second wave of Covid-19. Alappuzha Medical college was then the lone tertiary facility at that time in the district. The panel is trying to find out if the scrub nurse erred in complying with the final stage of the surgical safety checklist mandated by the World Health Organisation. 

The steps involve the Sign In stage when the patient's name, consent, surgical site and procedure are confirmed,  the Time Out stage before the incision when a verbal confirmation is done among the surgeon, anesthesist and the nurse regarding the patient, site, and procedure and the final stage; the Sign Out when instrument, sponge, gauze and needle counts are completed and specimens are labelled.

"In this case, the final count may have erred. However it is learnt that the procedure was done at a time when the entire health system was burdened by the pandemic spread. Still, the lapse is inexcusable. The panel needs to find out when exactly the lapse happened and who is responsible. For that the date of supply of the instrument is crucial," a source said. It is learnt that records showed nurse had verified the count of the instruments before suturing.

Senior consulant gynaecologists, Onmanorama spoke to, said that the incidence of RIS should be prevented. "There are chances that the instruments remain inert for years inside the body. Only when it impinges on organs, it causes rupture and complication. In this case, it may have perforated bladder and hence the condition of hematuria," a consultant said.

The doctors said that if the instrument is stuck in the omentum; a structure in the abdomen, it acts as a protective layer, preventing any damage to visceral organs.

Sindu J, who has been a neighbour of Usha for many years said that she would often complain of severe pain. "She used to go for employment guarantee scheme work even with that pain. Last week, the pain became unbearable and an examination revealed presence of surgical instrument," said Sindu. 

Jessy Sony, another neighbour and ward member, said that Usha has not mentioned about a surgery done in 2007. Sindu also said she was unaware of a previous surgery. Usha's husband Joseph and son Shibin could not be reached for comments. Senior doctors said that if at all the instrument had been left inside the abdomen in 2007, it would have been detected during the scan procedures ahead of her surgery in 2021.