Rectal Injury During Fibroid Surgery: What a Virginia Myomectomy Verdict Means for Injured Patients

On September 14, 2026, Virginia Lawyers Weekly reported a medical malpractice verdict out of Prince William County Circuit Court. The case is Coppa v. About Women, OB/GYN, P.C., Case No. CL25-5702, tried before Judge Angela L. Horan. According to the published verdict report, a jury returned a $2.5 million award, and with prejudgment interest the judgment came to $2,761,369.86. The court then reduced it to Virginia's statutory medical malpractice cap, which for an injury in late 2024 was $2.65 million.

The patient, Marlena Coppa, had a robotic-assisted laparoscopic myomectomy on November 19, 2024, at Sentara Northern Virginia Medical Center in Woodbridge. The surgeon, Ahan Hunter, M.D., planned to remove uterine fibroids and to bring tissue out through a posterior colpotomy, an incision through the back wall of the vagina. According to the verdict report, staff placed ring forceps against the posterior vaginal wall to mark the target, and Dr. Hunter made an incision about two inches long directly into the rectum instead of into the vaginal wall.

Two board-certified gynecologic surgeons testified for the patient that the standard of care required the incision to go into the posterior vaginal wall using known anatomical landmarks, and that relying on the forceps placement alone was not enough. At deposition and trial, according to the report, Dr. Hunter acknowledged that identifying the correct anatomy and making the incision were his responsibility as the operating surgeon, and he confirmed that he made the rectal incision. The defense offered no settlement before or during the five-day trial, and the jury deliberated about 80 minutes. A jury returned this verdict, so it is a finding of liability rather than an unproven claim, and we describe it here from the public verdict report and the court file. Post-trial motions or an appeal can follow any civil verdict, and we have no information that the parties have finished that stage.

Uterine fibroids are benign growths in the wall of the uterus. A myomectomy removes them while leaving the uterus in place, which is the reason many patients choose it over a hysterectomy. In a robotic-assisted laparoscopic myomectomy, the surgeon works through small abdominal openings and a camera, controlling the instruments from a console beside the table. Some myomectomies also use a colpotomy, an opening made in the vagina, to deliver fibroid tissue out of the body without a larger abdominal cut.

The rectum sits directly behind the posterior wall of the vagina, separated only by a thin layer of tissue called the rectovaginal septum. When a surgeon opens that posterior vaginal wall, the rectum is a few millimeters away. If the incision is aimed at the wrong plane, the blade can enter the rectum instead of the vagina. That is the mechanism the plaintiff's experts described in the Coppa case, and it is why an operation on the uterus can end in a bowel injury.

Bowel injuries during gynecologic surgery come from more than one place. Some happen at the very start, when the surgeon uses a Veress needle or a trocar to enter the abdomen. Others happen during the dissection itself, as a blade or an energy device works near the bowel. Both are recognized risks, and neither is rare enough to ignore. The medical question is never simply whether an injury is possible. It is whether the surgeon did what a careful surgeon would do to avoid it and to catch it if it happened.

Not every bad outcome is malpractice. Surgery carries risks that can occur even with careful technique, and a known complication listed on a consent form is not automatically negligence. The legal test is the standard of care, meaning what a reasonably careful surgeon in the same specialty would have done in the same situation. A complication that happens despite that care is a risk of surgery. A complication that happens because the care fell short is a claim.

The line usually turns on technique and response. Cutting without confirming the anatomy, ignoring the landmarks that mark where a structure begins and ends, failing to recognize an injury that a careful surgeon would have seen, or failing to get help and repair the damage promptly can each fall below the standard. Proving that generally requires a qualified expert, because a jury cannot judge surgical technique on its own. Our article on expert witnesses explains why medical malpractice cases rise or fall on that testimony and what it costs.

In the Coppa case the claimed breach was specific. According to the plaintiff's experts, the incision went into the wrong structure because the surgeon did not use anatomical landmarks to place it and relied on the forceps target alone. Consent forms for myomectomy often warn that bowel injury is a possible risk, and Dr. Hunter's records may well have included that warning. A signed consent form does not decide a case like this, because consent covers risks that occur despite proper care, not a departure from the standard of care.

Bowel injury in gynecologic laparoscopy is uncommon but serious. The largest review of it, published in Obstetrics and Gynecology in 2015 by Llarena, Shah, and Milad, pooled 90 studies from 1972 to 2014 covering 474,063 laparoscopies. It found bowel injury in about 1 in 769 procedures, or 0.13 percent. The small intestine was the segment hurt most often, in 166 of 354 injuries where the location was recorded, and most injuries in the review happened during the initial access with a Veress needle or trocar, in 201 of 366 cases where the cause was known.

The dangerous part is delay. In that same review, the diagnosis was delayed by more than a day in 154 of 375 cases, about 41 percent. Every death among the studied injuries followed a delayed recognition, a rate of roughly 1 in 31 among the delayed cases, while no deaths occurred among injuries that were found during the operation. The reason is straightforward. A hole in the bowel that goes unnoticed leaks stool into the abdomen and can cause a serious infection called peritonitis, and then sepsis, within days.

In the Coppa case, according to the verdict report, the injury was recognized during the operation. A general surgeon was called in to repair the rectum and to create a temporary diverting loop ileostomy, an opening that routes waste away from the healing repair. Prompt recognition is what the literature says separates a survivable bowel injury from a fatal one, and here it appears to have done exactly that. The harm that remained, according to the report, was the injury itself and its aftermath: about 15 days in the hospital including intensive care, a later ileostomy reversal, and persistent abdominal pain that the patient's side attributed to nerve damage or complex regional pain syndrome. A promptly repaired bowel injury can still leave lasting damage, and catching an injury quickly does not answer the separate question of whether it should have happened at all.

The proof lives in the file. The operative report shows what the surgeon intended and what was done. The general surgery consult and the repair note show how the injury was found and fixed. The anesthesia record, the nursing notes, and the pathology fill in the timeline. In a bowel-injury case, the operative note's account of how the injury occurred and when it was recognized is often the most important document in the chart.

How those records were created can matter as much as what they say. Our article on EMR audit trails explains how the electronic version of a chart shows the timing a printed copy hides, including when an entry was made, edited, or added after the fact. A note describing an injury that was written hours after the operation, or changed once a complication became clear, reads very differently once the audit trail is in front of a reviewer.

Other records fill out the picture: the consent form and the preoperative plan, imaging, the discharge summary, and the follow-up care such as emergency visits and pain management. If you want to know whether a surgeon had a prior record before your operation, our article on how to check a surgeon's disciplinary record before surgery walks through the license and board databases. Our article on surgical errors covers the wider category of preventable operating-room mistakes, including wrong-site surgery and retained objects.

In Virginia a medical malpractice claim generally has to be filed within two years of the date of the injury under Virginia Code Section 8.01-243, with only narrow exceptions and a separate ten-year outer limit measured from the negligent act. The state's discovery rule is limited, so the clock usually starts on the day of the surgery, not on the day you finally understand what went wrong. Other states set their own deadlines, and our article on the statute of limitations for medical malpractice explains how those clocks run and why they differ.

Waiting is the expensive mistake. Records get harder to obtain, memories fade, and a hospital that has closed your case has no reason to hold anything. The time to ask is now, while the answer can still help, not after the deadline has quietly passed. If a gynecologic surgery in the last couple of years left you with a bowel injury, have someone check the deadline before it runs.

Virginia also caps total damages in a medical malpractice case, which is why the Coppa judgment was cut to $2.65 million even though the jury and interest added up to more. The cap and the filing deadline are both fixed by law and both work against a patient who waits. Neither pauses because you are still healing.