Doctors Fail to Diagnose Bowel Leak After Colectomy, Leading to Sepsis and Death

This case takes place in Pennsylvania and involves a male patient who underwent a colectomy without complications in order to treat Crohn’s disease. After a few days of recovery in the hospital the man was discharged home, with instructions to return to the hospital should he develop a fever. Some time after returning home, the patient developed significant abdominal pain as well as a fever, and was instructed to return to the hospital the following morning by his primary care doctor. At the hospital, the patient was given additional medication to control his pain and fever and was released, however no additional testing was done at this time. After the patient returned home he continued to experience pain and an elevated fever, and he returned to the hospital the next day. On admission, it was noted that the patient had a distended abdomen as well as a lack of urine production. The treating physician ordered a CT scan, and the patient was given antibiotics. Hours later, doctors discovered a leak in the patient’s bowels from his earlier surgery, and the patient underwent surgery to repair the leak. Following surgery, the patient developed abdominal compartment syndrome and sepsis. The patient’s condition continued to deteriorate and the patient eventually died in the intensive care unit.

Question(s) For Expert Witness

1. Do you routinely treat patients similar to the one described in the case?

2. What could have been done to prevent the outcome for this patient?

Expert Witness Response E-008438

I frequently treat patients such as the one described in the case. I am a board-certified colorectal surgeon and this is my area of expertise. I have had patients with anastomotic leaks - it occurs in approximately 5% of sigmoid colectomy patients such as this. It is a well-described risk that I include in every surgical consent for colon resection. It is imperative that this is diagnosed quickly to prevent the outcome described in this case. I would have to review the operative report to see if there was anything that technically could have been done at the time of surgery to prevent the leak however, from the brief description above, it appears that there was a major delay in treatment of the leak and a delay in recognizing the emergence of sepsis and compartment syndrome. Earlier intervention would likely have made a major difference and the patient probably would have survived. I am double boarded (general and colorectal surgery) and work in a leading academic institution. I have an active practice performing colorectal resections laparoscopically, and I am responsible for the teaching and training of both general surgeons and colorectal fellows.