Improper Positioning of Patient During 4-Hour Long Surgery Causes Irreversible Neuropathy

This case involves a 60-year-old male patient who underwent an exploratory laparotomy, partial colectomy with end colostomy and take down of splenic flexure. He was taken in for a followup surgery to reverse the colostomy and experienced several complications as a result of the reversal procedure. The following morning the patient complained of severe lower limb pain associated with numbness and tingling. After a neurology consultation, the impression was that the patient developed left femoral motor neuropathy due to the 4-hour surgery in the lithotomy position. Further followup with neurology and electromyography (EMG) testing showed evidence of left upper lumbar radiculopathy with axonal degeneration involving the iliacus and quadriceps nerve branch distributions.

Question(s) For Expert Witness

1. Can this debilitating injury be prevented by careful positioning of a patient that is in need of extensive surgery in a position that compromises blood flow to critical nerve junctions?

Expert Witness Response E-000492

Absolutely this situation could have been prevented if the surgeon and support surgical staff realized that the patient was in a compromising position for an extended period of time. Anytime a patient is in any position other than the normal resting supine position, great care should be taken to ensure that improper blood circulation and nerve impingement is avoided at all costs.