Doctors Needlessly Delay Treatment of Septic Shock Following Colectomy

This case involves a male patient who underwent a colectomy to treat diverticular disease, and was discharged home on postoperative day 3. The patient was discharged with medications for pain and instructions to call the emergency room if a fever developed. While home, the patient began to complain of severe abdominal pain. Later that day, the patient developed a temperature of 101. The emergency room was called and informed of the fever, however the patient was instructed to take Tylenol and visit the doctor’s office in the morning. The patient was brought to his office, where the patient reported that he was still having abdominal pain, which the defendant attributed to the surgery. He increased his prescription for painkillers and discharged the patient with a follow-up scheduled a week later. The patient continued to experience abdominal pain, and did not urinate at all upon his return home. Eventually, the patient presented to the emergency room, where the emergency room doctor noted that the patient had a distended abdomen with decreased bowel sounds and tenderness in the lower right quadrant. IV fluids were started, a foley catheter was inserted, labs were ordered, antibiotics were given and a CT scan was ordered by the emergency room doctor. The results of the CT scan were significant for an anastomotic leak, and the defendant physician gave telephone orders to admit the patient to the Intensive Care Unit. The patient was not operated on for several hours, as doctors awaited the results of a second set of imaging studies. Eventually, the patient underwent emergency surgery to repair the bowel leak, which initially appeared to have been performed successfully. However, over the next few hours the patient’s condition continued to deteriorate rapidly. After a number of subsequent surgical interventions were unsuccessful, the patient was declared dead from septic shock secondary to ischemic bowel.

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 the outcome described in the case?

3. 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. This 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 is 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 abdominal 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 an academic institution. I have an active practice (the vast majority of my colorectal resections are done laparoscopically-such as the one in this case). In my current position, I am responsible for the teaching and training of both general surgeons and colorectal fellows.