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Q: Plastic surgery ( Answered 4 out of 5 stars,   3 Comments )
Subject: Plastic surgery
Category: Health > Medicine
Asked by: firebuild-ga
List Price: $100.00
Posted: 28 Oct 2003 09:23 PST
Expires: 27 Nov 2003 09:23 PST
Question ID: 270457
I am looking for a detailed explanation of what happens when a plastic
surgeon punctures a patient's intestine accidentally with a cannula
during a liposuction procedure: do the patient's vital signs drop? Is
it immediately
life-threatening? How does the surgical team mobilize to correct the
problem? I am writing a script and looking for a very dramatic plastic
surgery error that results in an emergency situation.  If this isn't
the right circumstance, I'm open to another. It needs to be a dynamic,
visually compelling situation.
Subject: Re: Plastic surgery
Answered By: journalist-ga on 28 Oct 2003 11:24 PST
Rated:4 out of 5 stars
Greetings Firebuild:

At the site
I located the following text regarding an organ puncture:
"A rare complication is perforation or puncture of an organ. The
procedure involves pushing a cannula vigorously through the fat layer.
If the doctor pushes too hard or if the tissue gives way too easily
under the force, the blunt hollow tube can go too far and injure
internal organs."

In the references for that page, I located one that reads:
"Taylor, Mia, Lloyd A. Hoffman, and Michael Lieberman. "Intestinal
Perforation after Suction Lipoplasty: A Case Report and Review of the
Literature." Annals of Plastic Surgery 38. No. 2: 169-172." [another
site listed 1997 as the year.]

I searched the Internet for an online presentation of the paper by
going to the Annals of Plastic Surgery website (and general Internet
searches) and the site is located at - I did an internal search there
for the report but the search includes only Jan 2001 through present. 
I did not locate a reprint purchase area but various emails may be
accessed on the site from the left hand column from "Journal

You may also be interested in the article offerings at;jsessionid=eanR7XtTFRDf


At is this
"A survey of members of the American Society of Plastic and
Reconstructive Surgeons reported complication rates of major
liposuction (not defined) based on 75,591 procedures. The
complications reported were: mortality (2); cerebrovascular accident
or transient ischemic attack (1); pulmonary thromboembolism (9); fat
embolism (1); major skin loss (5); anesthesia complication (23);
transfusion complication (10); and deep vein thrombosis (25)."

Also there is "Liposuction is contraindicated in patients with severe
cardiovascular disease, severe coagulation disorders including
thrombophilia, and during pregnancy.  A thorough medical history that
gives special attention to any history of bleeding diathesis, emboli,
thrombophlebitis, infectious diseases, poor wound healing, and
diabetes mellitus is taken. Patients with a medical history of these
conditions receive medical clearance prior to undergoing liposuction.
The history also includes prior abdominal surgery and problems from
past surgical procedures that may influence complications."


I located the following under the "Risks" heading:
"The main hazards associated with this surgery involve migration of a
blood clot or fat globule to the heart, brain, or lungs. Such an event
can cause a heart attack, stroke, or serious lung damage. However,
this complication is rare and did not occur even once in the study of
15,336 patients."


"A rare complication is perforation or puncture of an organ. The
procedure involves pushing a cannula vigorously through the fat layer.
If the doctor pushes too hard or if the tissue gives way too easily
under the force, the blunt hollow tube can go too far and injure
internal organs."

However, at are more
detailed study results:

"Of 93 liposuction deaths in 496,245 procedures, 23% were attributed
to thromboembolism, 15% to abdominal or visceral perforations and 10%
were from anesthesia, sedation or medication problems. Hughes [survey
10/1998 to 8/2000] found that the estimated overall risk of death from
liposuction was 8.4 in 100,000. The author reported mortality rates in
three categories of liposuction procedures. When liposuction was
performed alone (66% of procedures) the mortality rate was 1 in
47,415. When liposuction was performed with other procedures excluding
abdominoplasty (20% of procedures), the mortality rate was 1 in 7314.
When liposuction was performed with abdominoplasty, with or without
other procedures (14% of procedures), the mortality rate was 1 in

So, if you couple the liposuction with other surgical procedures, the
odds of life-threatening complications increase.


I did locate a site at
that offers two appendices beginning about 1/3 of the way down the

"Appendix II - Background Data on Four Patients Who Died After
Tumescent Liposuction"


"Appendix III. Liposuction Complications and Fatalities"

In the second appendix, there are details of the complications causing
fatalities such as:

"Med examiner report stated pt was found hooked to empty O2 tank, had
excessive amt of respiratory depressants in system."


"Fluid overload, blood loss - death due to cardiac arrest"

A scenario of cardiac arrest during liposuction would be plausible as
would excessive bleeding during surgery (perhaps free-bleeding due to
the intake of too much aspirin in the days before the surgery?  Or
patient forgetting to disclose the use of a blood-thinning agent such
as Coumadin to his/her doctor before surgery?  Or, in a more advanced
plot to include attempted murder, someone gave the patient Coumadin
without his/her knowledge to facilitate blood loss complications
during surgery?)  To me, excessive blood loss is a "visually
compelling situation."

The X-Files (season 4) once did an episode regarding a warlock doctor
who required certain deaths to rejuvenate his appearance/health. 
"Disk 2: Sanguinarium OH! The horror! The horror! 1960's heartthrob
Richard Beymer ("West Side Story") guest stars as a plastic surgeon
with a flair for alternative medicine. Bloody as all hell, but with
honest characterizations, and fine support from Tim Burton regular
O-Lan Jones as a white witch. Not an episode for the squeamish."  From

Coumadin is an anticoagulant. "These medications work by prolonging
the time it takes for your blood to clot...Anticoagulant medication
limits your body's normal ability to stop bleeding. For this reason,
you should be especially careful about activities that could produce
cuts or bruises. Any blow to the head could cause serious injury."


As you can see, there are various life-threatening problems that may
occur during a liposuction procedure.  In the case of excessive
bleeding, blood pressure would drop (as well as the surgeon noticing
excessive blod flow).  There is more than one choice for you.

After you have examined the various ways that complications have
happened and you wish for additional research for the specific
scerario you choose, please request a clarification regarding your
choice and I will do further research to detail that particular
scenario.  Please leave this question open and unrated until you feel
I have thoroughly served your research needs.

Best regards,


cannula intestinal puncture liposuction
"Intestinal Perforation after Suction Lipoplasty"
Annals of Plastic Surgery
Coumadin warning
X-Files plastic surgeon witch

Request for Answer Clarification by firebuild-ga on 28 Oct 2003 12:05 PST

Thanks, great work! I am most interested in the perforation scenario
because it's vital to my story that the injury be caused by the
physical error of the surgeon, not drug interaction or particular
patient sensitivities.  Is there a way to find out what, exactly,
would occur if such a perforation was made? What I'm looking for is
something that is serious and life-threatening but can be corrected by
the surgeon in the same room where he's doing the procedure (without
sending the patient to the hospital), and, hopefully, covered up in
such a way that the patient doesn't know exactly what happened.  I'm
open to injuries occuring during other procedures, but in my own
research I've found that liposuction seems to be the most dangerous
and significant plastic surgery.

Clarification of Answer by journalist-ga on 28 Oct 2003 13:13 PST
Glad you are pleased so far.  :)  I wanted to present you with other
options before going further.  I'll resume my research in the
perforation scenario - is it okay to examine other organ perforation
instances as well as the intestinal tract?

Also, may I include abdominoplasty [definition from
more commonly as a 'tummy tuck'...a major sugical procedure to remove
excess skin and fat from the middle and lower abdomen and to tighten
the muscles of the abdominal wall"] done in conjunction with
liposuction procedure?

I'll be researching further on the simple intestinal perforation
scerario while I await your clarification.

Best regards,

Request for Answer Clarification by firebuild-ga on 28 Oct 2003 13:29 PST
hi there, 

Sure, Abdominoplasty is fair game as well.  I'm interested in knowing
more about laparoscopy, mentioned in the comment below.


Request for Answer Clarification by firebuild-ga on 30 Oct 2003 08:39 PST

It seemed from your last post that you intended to provide a further
answer to this question, but I haven't seen anything else posted. 
Please let me know if you'll be responding further.  Thanks!

Clarification of Answer by journalist-ga on 30 Oct 2003 09:06 PST
I'm here and still on the quest.  :)  I've contacted two professionals
in the area and am hoping to gain some information from them.  I've
not abandoned you and I apologize for not thoroughly explaining my
continuing research strategy.

Thanks for your continued patience and I'll post more information as I
receive it.  Also, if anything else comes to mind regarding this
perforation scenario, please post it in a clarification for me to
include in my research.

Best regards,

Clarification of Answer by journalist-ga on 03 Nov 2003 08:12 PST
UPDATE:  Well, I have heard back from one liposuction firm in my town.
 I had left messages at that firm and another, and at this firm I had
also filled out a lengthy request for the info on their website.  In
today's mail I received a very slick packet of brochures and such
describing general plastic appears they did not bother to
read my query, they just used the address I provided to gather

I am phoning both again today as well as a professor of medicine at a
nearby university.  I appreciate your continued patience and I hope to
soon have a plausible scenario for you.

Best regards,

Clarification of Answer by journalist-ga on 05 Nov 2003 13:27 PST
So far, information is not forthcoming from liposuction doctors...both
that I phoned did *not* care to discuss scenarios of the nature I
described and I've had no word back from the university professor yet.
 So far, Surgeon-ga's comment below is the best I've seen and,
unfortunately, he/she is not a Researcher (Researcher names are
highlighted in blue).

I have, however, located a few scenarios that may be of some
assistance.  I'm not giving up the search yet for non-Internet
information so I hope you'll bear with me on that for a few more days.

Here's what I've located that may be able to be shaped to what you need:

"In 1997, the Medical Board obtained a temporary restraining order
against Dr. Matory ... A cosmetic surgeon, Dr. Matory convinced the
patient who died to undergo a twelve-hour combination surgery by
offering her price discounts. During the lengthy procedure, the nurse
expressed repeated alarm over the patient's extreme swelling, low
blood pressure, lack of urinary output despite significant fluid
infusion, and continued lack of consciousness. Dr. Matory, however,
said that the patient's condition was acceptable. At 11 hours into
surgery, the patient was unresponsive to stimuli and had only an
intermittent blood pressure reading. Dr. Matory considered taking her
to the hospital but did not do so, despite the anesthesiologist's
request. He also left the operating room and refused to return when he
was asked to do so by the anesthesiologist. Finally, over an hour and
a half after being unable to find a steady blood pressure reading, Dr.
Matory agreed to take the patient to the hospital. Ten minutes later,
the patient had no heart beat. She arrived at the hospital in
respiratory and cardiac arrest, and an emergency thoracotomy revealed
that her heart was empty of blood."


"The Medical Board filed an accusation and obtained an interim
suspension order against Dr. Chavis, a plastic surgeon, in 1997. The
accusation centered on his treatment of eight patients, one of whom
died. Three of the incidents, which involved elective liposuction
surgery, took place within a two-month period. In the first incident,
according to the Medical Board, Dr. Chavis took the patient to her
hotel following the liposuction procedure, despite the fact that she
was vomiting, sweating, had nausea, had urinated in the car, and was
unable to walk unsupported. When blood gushed down the patient's pants
as she attempted to enter the hotel, Dr. Chavis decided to take her to
his house instead. Once at his house, she was not given any food or
medication and, despite her continued heavy bleeding, she was not
monitored by Dr. Chavis or a trained nurse for a 24-hour period.
Although her symptoms continued for several days, Dr. Chavis responded
to her complaints with only a vitamin injection and hot packs. The
patient ultimately checked herself into a hospital, where it was
discovered she had lost 70% of her blood volume and 40 pounds. She
required significant blood transfusions, and her symptoms did not heal
for four months.
Less than six weeks later, a second patient suffered major blood loss
following the same surgery. When this patient went to the emergency
room after discovering that her bed was soaked with blood, Dr. Chavis
convinced her to leave the hospital and go to his house to recover.
There he left her in the care of his 18-year-old, untrained niece, who
subsequently went out, leaving the patient alone. The patient later
required emergency hospitalization for blood loss and infection.
During the time that this patient was at his home, Dr. Chavis started
a procedure on the third patient. Following the surgery, this patient
complained of pain and had a high pulse rate and low blood pressure.
While she was still exhibiting these symptoms, Dr. Chavis left her to
go home to check on the second patient. Two hours later a nurse
noticed that her heart beat was faint and that she was barely
breathing. The nurse called 911, but the patient died. She, too, had
lost 70% of her blood volume."

These are both located at and
there is more information on both cases.


Cosmetic surgeon loses $1.6 million judgment
The family of a woman who died after liposuction sued Dr. Barry Miller

"During the procedure, however, Miller penetrated Sousaris' abdominal
wall with the liposuction instrument, says Richard Fried Jr., her
family's attorney.

"Dr. Paul Cordts, a staff surgeon at Tripler Army Medical Center,
testified in a prehearing brief that the suction caused Sousaris'
small intestine to follow and stick to the instrument as it was
withdrawn through the abdominal incision."

More on the outcome at the above link.


"Ultrasonic liposuction is a very new technique. There are now two
main types of ultrasonic liposuction: INTERNAL (with the vibrating
cannula) and EXTERNAL (done by a vibrating machine just prior to the
liposuction procedure). It can be performed with either the
traditional, wet or tumescent methods....
Unfortunately, the ultrasonic equipment used (referred to as cannulae,
or tubes) may overheat and has caused burns to patients. Recently,
ultrasonic cannulae have perforated patients kidneys and gallbladders.
Additionally, Ultrasonic Liposuction may cause "end hits", a burning
through of the surface skin. "End hits" occur when the ultrasonic
cannula pushes on the skin from the inside out, resulting in blister
formation and sometimes scarring."



Anatomy example (streaming video) regarding safe liposuction areas
from - this site also
offers a very comprehensive patient guide to liposuction at


I'll update you on the outside information as soon as I receive it.

Best regards,

Request for Answer Clarification by firebuild-ga on 06 Nov 2003 13:00 PST
Thanks. I will keep an eye out for your further research.  I am very
interested in the scenario from surgeon, too, but what's missing from
that are details on how the repair would be accomplished with
laparoscopic surgery without the patient knowing it had happened.  I
guess that would be a new question, though.

Clarification of Answer by journalist-ga on 06 Nov 2003 14:45 PST
It's that pesky repair scenario that's alluding  However,
that's part of your original question and I am striving to answer it. 
I have some feelers out in other areas and I really appreciate your
continued patience.

Best regards,

Clarification of Answer by journalist-ga on 10 Nov 2003 08:53 PST
I located a detailed rundown of a Laparoscopic repair of a Duodenal
perforation at - it shows
diagrams and explanation including:

Preparation of the patient. 

Creation of pneumoperitoneum. Insertion of port. 

Diagnostic laparoscopy & locating the perforation. 

Cleaning the abdomen. 

Closure of the perforation with an omental patch.

Irrigation and suction of operating field. 

Final Diagnostic laparoscopy for any bowel Injury or haemorrhage. 

Removal of the instrument with complete exit of CO2. Closure of wound


Also see another good explaination and overview of the procedure at


The thing about a laparoscopy is that because gas is used to distend
the abdomen during the surgery, a patient might question why there is
so much "pressure discomfort" because of that.  Your liposuction
doctor would have to be skilled in laparoscopy to be able make this
kind of repair on the sly without the patient knowing.

Let me know if the above information is of assistance.  I'm still
having no luck with getting a surgeon to speak with me.

Best regards,


laparoscopy procedure
laparoscopy explained
Laparoscopic surgery abdominal perforation
firebuild-ga rated this answer:4 out of 5 stars
not exactly what I was looking for, but very helpful nonetheless.

Subject: Re: Plastic surgery
From: omniscientbeing-ga on 28 Oct 2003 09:26 PST
The TV show "Nip/Tuck" might offer several such screenplay situations.

Google Answers Researcher
Subject: Re: Plastic surgery
From: surgeon-ga on 28 Oct 2003 12:53 PST
If intestine were injured, it's possible they'd see intestinal content
in the suction bottle: the nurse might tell the doctor there's some
green stuff in the collection bottle. It's conceivable that they could
perform laparoscopy, identify the injury, and sew it up without
significantly changing the outcome of the original surgery, and the
patient might not know. However, it would take the complicity of the
entire team, and the surgical center administrators. Many plastic
surgeons, especially if very recently trained, might have had enough
abdominal laparoscopy training to pull it off. However, what's most
likely in real life is that a general surgeon would need to be called
in. I suppose that surgeon could be pursuaded to keep mum under the
dastardly conditions of artistic imagination. In the real world, given
the consequences, it's pretty much a given that the truth would out
very quickly.
Subject: Re: Plastic surgery
From: journalist-ga on 30 Nov 2003 19:22 PST
Thank you for your kind words, Firebuild.  :)  I continue to put out
feelers for this information but none is yet forthcoming.  I spoke
recently with a friend whose ex is a surgical nurse (they are still
friendly) and he said he'd inquire if she could address the topic. 
This was about a week ago and I'm hoping something comes of it. 
Fingers crossed.

Know I continue to seek an exact description for you.  Answered
questions remain open to comments so you will hear from me should I
ever locate a surgeon or surgical nurse willing to speculate openly on
your topic.

Best regards,

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