Attitude 11

It happened while I was on vacation. One of the patients transferred to us in labor underwent an emergency cesarean section for placenta previa. She was found to have partial placenta accreta. The obstetrician managed to remove all placenta and control placental site bleeding with underrunning sutures. Postoperatively she developed abdominal distension which kept on increasing. An ultrasonic scan showed a large hematoma in the left broad ligament. A CT angiography was done, which confirmed the presence of the hematoma, without any vessel bleeding actively. She was explored immediately thereafter, 4 days after the cesarean section. At laparotomy she had a clean abdmonen and pelvis. There was no extraperitoneal hematoma. The abdomen was closed. When I met a senior staff member from the department of radiodiagnosis, I gave this feedback. That person said “if two radiological examinations (USG and CT) showed a hematoma, it must be there. How can it not be there?” I said there were 4 senior witnesses, just so that a claim of negligence in noticing the hematoma was not made. She said “perhaps it was dissolved and absorbed due to medication.” I wanted to know which medication would achieve it, so that we would give that to all patients like this instead of exploring them. She had no answer. So I said the problem was in her department, and she better sort it out. She immediately went on the defensive and said, “it is always easy to put the problem in our department.” I was stunned. That a visual diagnosis should be claimed to be wrong believing two imaging modalities, and that no effort should be made to correct the error were two different things, both of which were beyond comprehension.