Mismanagement of Elective Cholecystectomy Causes Severe Electrolyte Imbalance

This case involves a 46-year-old female patient who presented to the hospital for elective cholecystectomy. The patient was admitted to the hospital for almost a week to rule out the possibility of gall bladder carcinoma and was kept NPO for 7 days. Lab work showed that she was dehydrated and had severe electrolyte imbalances at which point the house staff aggressively gave fluid resuscitation. The surgery was less than 24 hours away when the lab work showed the dehydration and electrolyte disturbances but the surgery was continued anyway. The physicians experienced great difficulty intubating the patient.

Question(s) For Expert Witness

1. Was this patients surgery necessary given her status right before surgery and the fact that it was elective in nature, could it have been delayed until she was more stable?

Expert Witness Response E-001161

There are several steps the physicians in charge should have taken to properly workup this woman once gallbladder cancer was suspected. Tumor marker studies can be reavealing if the clinical suspicion is high. Additionally, several of the following tests should have been reviewed before surgery. Liver function tests: Elevated alkaline phosphatase and bilirubin levels are often found with more advanced disease. BUN, creatinine, urinalysis: Assess renal function prior to performing an enhanced CT scan. CBC: Anemia may be an indicator of more advanced disease. I believe this case warrants further review in light of the fact that the initial workup of the patient involved suspected cancer, therefore I think the physicians giving care to this patient should have looked into a few other venues before sending this woman into surgery.