“I Knew Something Was Wrong on Day Two”: Bowel Injury During Surgery and When It Is Negligence

Surgical and hospital care guides · 15 min read · Published 10 November 2026 · Reviewed 10 November 2026 · Next review May 2027

By Dr Rosemary Listing, PhD (Law) · Medical negligence lawyer since 2014 · Of Counsel, Peter Evans & Associates

If you are reading this after an operation where your bowel was injured, or after days of being told your pain was normal, I want you to know your instincts were worth listening to. Bowel injuries are a recognised risk of surgery. Missing them is a recognised danger too.

This guide is for anyone who has had keyhole or open surgery in the abdomen or pelvis, including gynaecological, general and urological surgery. It covers how bowel injuries happen, how common they are, the warning signs afterwards, what should happen when someone isn’t improving, what your records should show, and how the law looks at it.

Start with your question

• How does the bowel get injured during surgery?
• How common is bowel injury in keyhole surgery?
• What are the signs of a bowel injury after surgery?
• When is pain after surgery an emergency?
• What should happen if I’m not improving?
• Will I need a stoma?
• When is a bowel injury medical negligence?

How the bowel can be injured

In keyhole (laparoscopic) surgery, the surgeon works through small cuts using a camera and long instruments. The bowel lies just beneath the abdominal wall and around the organs being operated on, so it is close to every step.

How common is it?

Serious injury is uncommon. The Royal Women’s Hospital in Melbourne tells patients having laparoscopy for endometriosis that damage to organs such as the bladder, bowel or ureter happens in about 1 in 500 operations, and that delayed diagnosis of organ damage, needing a second operation, happens in about 1 in 3,000.¹ The risk is higher where there is a lot of scar tissue, and should be discussed with you before surgery.

Before surgery

Questions to ask

• Does my previous surgery, endometriosis or scar tissue raise my risk of bowel injury?
• What will you do to reduce that risk?
• If the bowel is injured, will you check for it and repair it during the operation?
• Is there a chance I’ll need a stoma?
• What should I expect each day afterwards, and what would worry you?

The warning signs afterwards

After keyhole surgery, most people feel a little better each day. A 2008 review of 130 laparoscopy-related bowel injuries stressed that a patient who fails to show steady improvement should raise suspicion. It described the typical picture of a missed injury: persistent and worsening pain, often with nausea, vomiting, fever, chills, weakness or laboured breathing. Early on, temperature and blood pressure may be normal, while the heart rate and breathing rate are fast. Fever and low blood pressure tend to come later.²

Timing matters. In that review, sepsis was present in all of the large bowel perforations and half of the small bowel perforations diagnosed more than 48 hours after surgery.²

Expected, worth a review, or emergency

A general guide only. Your surgical team’s instructions come first.

What should happen if you aren’t improving

When someone isn’t recovering as expected, the response should be a careful examination, blood tests, and a review by a senior surgeon, often with a CT scan. In a New Zealand case decided by the Health and Disability Commissioner, a bowel injury during gynaecological keyhole surgery went unrecognised. Over a weekend, a junior doctor escalated concerns, but the senior doctor did not review the patient in person or arrange imaging. The Commissioner found that this delay breached the patient’s right to care with reasonable skill, and also criticised the hospital for systems issues, including a consent form with no space to record her particular risks.³

Repair, and sometimes a stoma

An injury found during the operation can often be repaired straight away. An injury found later, especially after infection has set in, may need a larger operation, a period in intensive care, and sometimes a temporary or permanent stoma, where the bowel is brought out onto the tummy wall. In the New Zealand case, the patient needed part of her bowel removed, a colostomy and many further operations.³

If you felt brushed off, see when being dismissed by a doctor becomes a legal issue. Infection that spreads into the bloodstream is covered in sepsis and when it becomes negligence.

What to look for in the records

Your records are often where the story becomes clear. You have a right to access your own health information. In NSW the Health Records and Information Privacy Act 2002 covers both public and private providers, and the Information and Privacy Commission explains how to ask.⁴ Our step-by-step guide to getting your medical records in Australia walks you through it.

How the law looks at it

A bowel injury during surgery is not, on its own, negligence. It can happen even with careful technique, particularly where there is a lot of scar tissue. The legal questions are whether the surgery and aftercare met the standard expected, and whether any shortfall caused harm.

A claim usually turns on three questions: whether the care fell below what peers would widely accept as competent practice (section 5O of the Civil Liability Act 2002 (NSW))⁵, whether that shortfall probably caused harm you wouldn't otherwise have had (Tabet v Gett)⁶, and, where it matters, whether you were told the material risks first (Rogers v Whitaker)⁷⁸. Our guide to how a medical negligence claim works explains each one in plain terms.

In a bowel injury case, the questions might be: were your particular risks assessed and discussed? Was the surgery performed with accepted technique? Was an injury that should have been seen at the time missed? When you weren’t improving, were you reviewed by a senior doctor and investigated promptly?

In plain terms, the question is often about delay: would earlier recognition probably have meant a smaller operation, avoided sepsis or a stoma, or shortened your illness?

For abdominal and pelvic surgery, that would usually include the risk of bowel injury, how your history affects it, and what would happen if an injury occurred.

Who can claim, and when

The person who had the surgery can claim. If someone died, members of their family may be able to bring a claim. In NSW, time usually runs from when you knew, or ought to have known, enough to claim, not from the treatment itself, and courts can sometimes extend it, so an old injury may still count. See time limits in NSW or other states, and ask early.

More: complaint or claim? · how a claim is paid for · what a claim can cover

In my practice

In the bowel injury files I read, the injury itself is often accepted as a recognised risk. The case turns on the hours afterwards. A heart rate creeping up on the chart. Pain getting worse when it should be getting better. A junior doctor who examines, writes “? gas”, and decides not to wake the consultant. A scan that waits until morning. Each decision seems reasonable at 2 am. Together they can be the difference between a small repair and a stoma. Patients often tell me they knew. They knew because they had been through pain before, and this was different. The records frequently show that their bodies were saying the same thing.

Both things can be true

Your surgeon may be skilled and careful, and an injury may still have happened. The nurses and junior doctors may have been stretched and kind, and the warning signs may still have been missed. You can be grateful to the team who found and repaired the injury and still want to know why it took so long.

The bigger picture

Keyhole surgery has made recovery faster for most people, but it has also changed how some injuries present. A burn from an energy device may not be visible at the time and can break down days later, which is why the days after surgery matter so much.² The New Zealand Commissioner’s report recommended that the specialist college consider whether its laparoscopy guidance needed revising, and criticised the hospital for staff being unaware of it.³

You can check any practitioner’s registration on the Ahpra public register,⁹ and complaints about care in NSW can go to the Health Care Complaints Commission.¹⁰ If your surgery was for endometriosis, see our guide to laparoscopy for endometriosis and our endometriosis and gynaecology page.

Support

You don't have to work through this alone. These services can help:

• Lifeline, 24-hour crisis support: 13 11 14 (listed on healthdirect's helplines page)¹¹
• Beyond Blue, anxiety and depression support: 1300 22 4636
• Medicare Mental Health, help finding mental health support: 1800 595 212
• healthdirect, 24-hour nurse advice: 1800 022 222
• Health Care Complaints Commission (NSW): 1800 043 159

A woman who lay in the dark knowing it wasn’t gas now has the records that prove she was right. You deserve that clarity too.

With care,
Rosemary

Frequently asked questions