Inability to Reverse Colostomy Due to Poor/Friable Rectal Tissue

This case involves a 31-year-old female with a past medical history of HTN, DM, OSA, and Obesity. The patient had been struggling with complicated diverticulitis that subsequently resulted in a perforated bowel with several abscess formations that were initially treated conservatively. The patient underwent surgical exploration that ended with a left hemicolectomy with an end colostomy. Her condition has been deteriorating ever since the original Hartmann’s procedure and the surgeons are unable to reverse the colostomy due to poor/friable rectal tissue. Current recommendations from physicians are to wait 9-12 months before any reattempts are made to reverse the colostomy.

Question(s) For Expert Witness

The attorney on this case would like a General surgeon to review the medical records to determine if there was any evidence of substandard care. What are your initial thoughts on the situation?

Expert Witness Response E-000638

The case, as described, is somewhat unusual. Active, perforating diverticulitis is very uncommon in a 31 year old woman. Her associated conditions complicate her course, but are not causative. The percentage of diverticulitis cases at age 31 is well under 5%. Also, the operation, as described, a Hartmann procedure with end colostomy, usually treats the condition very well. As stated, her rectal tissue remains "poor/friable'. and this is unusually the case. With the bowel diverted, the inflammation in the pelvis usually subsides and the patient's condition should improve, not deteriorate. Hypertension and diabetes become easier, not more difficult to stabilize. It is speculation, of course, but, I wonder if this patient has a disease other than diverticulitis. Crohn's disease would more likely have this course. Ulcerative colitis could, but Crohn's disease is more likely. I would like to review the pathology report as well.