Colorectal Surgery Expert Comments on Necrotizing Pancreatitis After Laparoscopic Cholecystectomy

This case involves a female patient who suffered multiple complications including persistent bile leakage and necrotizing pancreatitis following a laparoscopic cholecystectomy. She presented to the emergency room complaining of abdominal pain, heartburn and indigestion. She was discharged home with prescriptions for a painkiller and antacids. She was instructed to return to the emergency room if her symptoms persisted. She was seen for follow-up some time later, where she was noted to have had persistent pain and discomfort since surgery. Imaging was performed, which discovered potential evidence of a bile leak. The patient was not admitted at that time, but returned to the hospital later on, complaining of episodic abdominal pain. Another scan was concerning for a bile leak, and the patient was transferred to another medical center per the Defendant’s instructions. Here, the patient underwent an endoscopic procedure to repair the leak. The patient continued to have a persistent leakage as well as pancreatitis until she ultimately developed necrotizing pancreatitis.

Question(s) For Expert Witness

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

2. Have you ever had a patient develop an outcome similar to the one described in the case?

3. Are bile leaks a common complication of the procedure?

Expert Witness Response E-019586

I routinely see patients with bile leaks post cholecystectomy - it is a fairly common complication of cholecystectomy. This case involves what is described as a Duct of Luscka leak - the presence of an anomalous Duct of Luscka is also fairly common. I am well qualified to opine on the management of bile leaks and any deviations from the standard of care. In this case there appears to be a deviation from the standard of care, given the fact that the patient continued to experience these symptoms for such an extended period of time. I am a gastrointestinal surgeon at a major academic center, and I am boarded in Surgery and Colon-Rectal surgery. I routinely perform and teach laparoscopic cholecystectomy, and I routinely manage similar complications sent by referral from outside hospitals to our tertiary referral center.