Undetected Perforation in Colon Kills Patient

Joseph O'Neill

Written by
— Updated on October 9, 2017

General Surgery Expert WitnessThis case involves an older female who presented to her primary care doctor on with complaints of vomiting, fatigue, and loss of appetite. The doctor diagnosed the patient with Irritable Bowel Syndrome. The next day, the patient presented to the ER with a distended stomach, abdominal pain, gas, and sweats. A CT Scan revealed a significant intestinal blockage, as well as free air in the abdomen. The patient was taken in for emergency surgery. The surgeon was unable to find a leak and sent her to the recovery floor.

Several days after the emergency surgery the patient felt fatigued, with a fever and an elevated white blood cell count. She was told she had an infection and would be treated with antibiotics. She had abdominal pain, which prompted a CT scan which revealed a perforated colon. She was then rushed for emergency surgery to repair the perforation, however she expired shortly after the surgery was completed.

Question(s) For Expert Witness

  • 1. How often do you treat patients with these presenting complaints?
  • 2. What is the standard work up when a perforated colon is suspected?
  • 3. Do you believe this patient may have had a better outcome if the care rendered had been different?
  • 4. Have you ever served as an expert witness on a case similar to the one described above? If so, please explain.
  • 5. Please tell us why you’re qualified to serve as an expert reviewer of this case.

Expert Witness Response E-001161

As a general surgeon, I take care of patients with abdominal pain, bowel obstruction and colon pathologies on a regular basis. It is highly disappointing that the clinical team was not able to appropriately diagnose the colonic issues with the preoperative imaging, and the evaluations while in surgery. There is question as to whether the operation was performed appropriately, because a finding of “free air” in the CT scan prior to the operation usually means that there is a perforation somewhere along the GI tract. During surgery, it seemed like a kink in the bowel was found, but the perforation was missed. It is likely that the patient would not have died had the colonic perforation been appropriately addressed during surgery. I have not served as an expert witness in a similar case.

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