Congressman John Murtha of Pennsylvania died last week at Bethesda Naval Hospital as a result of complications following gallbladder surgery. While it is not possible to comment on the medical care rendered to Congressman Murtha without a thorough review of his medical records, it can be said that “complications” from gallbladder surgery can often be the result of medical negligence.In order to understand what may have happened to Congressman Murtha, you have to understand the anatomy of the gallbladder. The gallbladder is an organ that secrets bile into biliary system to aid in breakdown of food. The gallbladder is a sac that attaches to a structure called the cystic duct. The most common complication associated with gallbladder surgery are cutting the wrong structure and severing the biliary tree. Nearly as common is perforating one of the surrounding structures, usually the small intestine, although perforations to the colon are also common. Less common are perforations of the bladder.In Congressman Murtha’s case, it appears that there was a perforation of his small intestine. Can this happen in the absence of negligence? Absolutely. Sometimes a perforation can occur when the surgeon is taking down scar tissue, called adhesions. However, such perforation must be recognized and addressed at the time of surgery. Failing to find and repair perforations during surgery can be negligence or medical malpractice.Often, the real case for malpractice is when the surgeon fails to recognize that a perforation has occurred. In the event of a peroration during surgery, particularly of the small intestine and colon, the result is usually an infection or sepsis. The most common symptoms or complaints following a perforation are severe abdominal pain, fever, elevated white blood count, and x-rays showing air accumulations in the abdomen. If any or all of these are present, the doctor should be considering whether a perforation has occurred. In that case, exploratory surgery is almost always indicated.Delays in treating perforations can lead to massive infections and death. Those that survive these infections can be left with damage to their bowels and bladder and ongoing abdominal pain.