Man is Killed by Undetected Hernia Following Gastric Bypass Surgery

This case involves the death of a middle-aged man who had recently undergone gastric bypass surgery from an internal hernia. The man had called the office of his gastric surgeon and reported a severe constipation problem. Despite his serious complaints, he was never referred to the ER. A few days later, he presented to the ER where he was found to be tachycardic and hypotensive. A CT Scan showed bowel ischemia, and a plan was made to operate on the patient when he was stabilized. Over the next several hours the patient continued to deteriorate, and the decision was made to operate emergently, however the patient died before surgery could be performed. An autopsy reported that the cause of death was a gangrenous internal hernia.

Question(s) For Expert Witness

1. Do you routinely treat patients like the one described above? How long have you been practicing in this capacity?

Expert Witness Response E-001161

As a fellowship-trained bariatric surgeon, I commonly perform operations similar to the one described. I have published on bariatrics and critical care. I have not had a similar outcome as the one described above. In reading the brief summary, there are many concerns that come to mind. An internal hernia is a serious complication of this operation and cannot be diagnosed unless the patient is evaluated by a clinician. Therefore, not directing the patient to the ED is inappropriate. Furthermore, outside of the unacceptably long time it took to get a CT scan, the patient may have been considered for a diagnostic laparoscopy if his condition was deteriorating. This would be predicated upon his clinical signs and symptoms. Finally, waiting for a patient to "stabilize" prior to taking him to surgery may also be inappropriate, since the reason for her condition is the internal hernia. In such a case, the patient will not stabilize until the hernia is surgically repaired, and waiting for clinical improvement is an error in judgment.