Bowel surgery and diagnostic procedures such as colonoscopy carry inherent risks — but they also carry a duty to be performed to the standard of a reasonably competent surgeon or endoscopist. Bowel perforation, missed perforation causing peritonitis, and anastomotic leak are among the most serious complications in abdominal surgery. When these result from a failure below the required standard — or are not recognised and treated in time — serious and sometimes life-threatening harm can result.
When is colonoscopy and bowel perforation negligent?
Colonoscopy — a procedure in which a flexible camera is passed through the bowel — carries a risk of perforation of approximately 1 in 1,000. Where perforation occurs due to excessive force, poor technique, or failure to recognise that the bowel wall has been breached, a claim may succeed if the perforation fell below the standard of a competent endoscopist.
More importantly, failure to recognise a perforation at the time — or promptly when symptoms develop — can transform a manageable surgical complication into a life-threatening peritonitis. A patient who develops abdominal pain, fever, and peritonism after colonoscopy requires urgent investigation and return to theatre. Delayed recognition and treatment is a common basis for claims.
When is an anastomotic leak after bowel resection negligent?
When bowel is resected (removed) and the cut ends are joined together (anastomosis), the join can leak — causing bowel contents to spill into the peritoneal cavity. An anastomotic leak is a potentially fatal complication. Claims arise where:
- The anastomotic technique was below the required standard, increasing the risk of leak
- The post-operative signs of anastomotic leak — fever, tachycardia, deteriorating CRP, peritonism — were not recognised and acted upon in time
- Return to theatre for washout and revision was delayed
When does a wrong bowel resection amount to negligence?
Surgery on the wrong segment of bowel, removal of a greater length than clinically indicated, or failure to complete a required resection (leaving tumour behind) are potential bases for claims.
When is failure to advise and consent for a stoma or colostomy negligent?
Patients undergoing bowel surgery may require a temporary or permanent colostomy. Failure to discuss the realistic risk of a permanent colostomy before surgery under the Montgomery standard, and the patient subsequently requiring a permanent stoma they were not prepared for, may give rise to a consent-based claim.
SCRIPT 68 — Retained Placenta, HELLP Syndrome, and Umbilical Cord Compression Claims
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Frequently asked questions
Can I claim if my bowel was perforated during a colonoscopy?
Possibly — if the perforation resulted from technique below the required standard. Not all perforations are negligent; the question is whether a competent endoscopist performing the procedure to the required standard would have caused the same injury.
Can I claim if an anastomotic leak was not recognised in time?
Yes — if the signs of anastomotic leak were present and not acted upon promptly, and the delay in return to theatre caused additional harm.
Can I claim if I was not told I might need a permanent colostomy?
Yes — under the Montgomery standard, where the risk of a permanent stoma was material and was not disclosed before surgery, a consent-based claim may arise if you underwent surgery and were left with a permanent colostomy you had not been warned about.