Gastroenterology Expert Evaluates Untreated Duodenal Perforation

Case Overview

This case involves a man who retained a stone in his bile duct following a surgery on his gallbladder. An endoscopic visualization procedure known as an ERCP was performed, after which physicians noted that there may have been a perforation in the patient’s duodenum. Despite the fact that the perforation was identified, it was not treated directly, with doctors orders for conservative monitoring and antibiotics. Nevertheless, the patient continued to suffer difficulties related to the perforation that necessitated additional surgeries, an extended hospital stay, a months-long rehabilitation period, as well as disfiguring scarring from the repair procedures. It was alleged that the patient’s duodenal perforation should have been treated more aggressively, and that earlier intervention would have prevented his negative outcome.

Questions to the Gastroenterology expert and their responses

Do you routinely perform ERCPs?

I routinely perform ERCP procedures, including over 300 last year alone.

Have you ever had a patient develop the outcome described in the case?

I have had a patient develop a perforation related to an ERCP procedure before. Generally speaking, perforations can be duodenal or periampullary.

Do you believe there may have been a deviation in the standard of care that contributed to this patient's poor outcome?

It is difficult to say if there has been a deviation in the standard of care without knowing the specifics of the perforation and the details of the care administered. Similarly other questions include whether there was anything other than antibiotics administered, such as nasogastric tube suction, an attempt at endoscopic perforation closure using an OTC clip, or other varieties of intervention.

About the expert

This highly qualified expert obtained his MD and residency in Internal Medicine from the prestigious Johns Hopkins Hospital. He then went on to complete a fellowship in Gastroenterology at Brigham and Women's Hospital. He also did an advanced fellowship in Gastrointestinal Endoscopy at Johns Hopkins. He is a member of numerous prestigious societies such as the American Society for Gastrointestinal Endoscopy and the American College of Gastroenterology. He has published 74+ peer-reviewed articles, case reports, and book chapters in the field of Gastroenterology. He is currently an Assistant Professor of Medicine, the Director of the Pancreatitis Center, and Medical Director of the Pancreatic Islet Autotransplantation Program at a Top 5 Tier University.