MYSTERY FILM Defendant Lauren Swords, MD, FACOG, says she would have visualized the patient's uterus after a C-section and removed all debris before closing.

No one seems to know how 2 pieces of plastic film ended up in the uterus of an Illinois woman who'd had 4 operations in her abdominal area over a 7-year span, but a Chicago hospital and 2 physicians have been deemed the most likely culprits and are now facing negligence charges.

After experiencing pain, heavy bleeding and vaginal discharge in 2013, April McCaster underwent exploratory surgery. That was when the 2 thin plastic pieces — each about 8.4 cm by 6.6 cm — were found.

She'd had an emergency appendectomy in 2003, a C-section in 2004 and an abortion in 2005, but she traced her discomfort back to a second C-section, in 2009, at Chicago's Mercy Hospital & Medical Center, and sued the hospital and 2 physicians.

The defendants fought to have the case dismissed. Kathy Jones, MD, who performed the 2009 C-section, recalled it as routine and uneventful. And all the counts all added up, according to hospital records. Plus, none of the doctors or nurses who were present recognized the plastic or had any idea where it might have come from. Lauren Swords, MD, FACOG, who was a resident at the time and who did the case with Dr. Jones, said one of them would have visualized the uterus and removed all clots and debris before closing. Dr. Jones added that she would have ensured the surgical field was clear and no foreign objects had been left behind.

But if they didn't leave the plastic strips behind, who did? During her 2003 appendectomy, the surgeon used a plastic specimen bag to remove the appendix. But Ms. McCaster had no complications, and an expert testified that not only was a different kind of plastic used, but also that it was unlikely that an object left in her abdominal cavity would migrate through her uterine wall. After her 2004 C-section, Ms. McCaster went to the emergency room complaining of fever and abdominal pain. There, doctors performed a vaginal exam, found an infection and admitted her, but after several days she left with no pain or abnormal discharge. And she had no pelvic or abdominal pain after her abortion in 2005.

Experts also testified that it would have been difficult for her to get pregnant if the plastic had been left behind during the first C-section, and that Drs. Jones and Swords would have likely seen something either during the 2009 C-section, or on one of the ultrasounds that preceded it.

The case rests on a legal doctrine known as res ipsa loquitur, meaning "the thing speaks for itself." In other words, even if no one saw it occur, there may not be any other reasonable explanation. So barring a settlement, it will now be up to a jury to decide, "as unsatisfying as it may be to attempt to solve a mystery without explaining how the essential event happened," said the judge.

Jim Burger