Patient Develops Bowel Necrosis From Negligent Feeding Tube Placement

This case involves a 35-year-old female patient who presented to the hospital with severe head trauma she sustained when she fell on the concrete stairs of a sporting event stadium. The patient suffered severe facial lacerations and fractures and was immediately taken to the operating room for repair. A tracheostomy was performed, along with IVC filter, and tube placement. Neurosurgery placed an external ventricular drain and the critical care team was consulted for ventilatory support. Tube feeds were initiated and the external ventricular drain was removed. Following the external ventricular drain removal, the patient spiked a fever. The physicians investigated the patient for infection with negative results. In response, the patient was given preventive treatment for a sinus infection. The patient was eventually weaned off her ventilator but began showing signs of altered mental status and declining consciousness. A head CT was obtained which did not reveal any changes. The patient subsequently became hypotensive and was returned to the ICU, placed back on a ventilator, and administered hemodynamic support. Further workup identified the presence of portal-venous gas. The patient was then sent back to the operating room for an exploratory laparotomy. During the procedure, it was discovered that a significant amount of feeding tube contents had leaked into the patient’s peritoneal cavity. The tube was removed and gastric wedge resection was performed. After the procedure, the patient suffered from refractory shock. The patient was taken back to the operating room where diffuse bowel necrosis was discovered. The patient eventually passed away from these complications. An expert interventional radiologist was sought to assess the accuracy of the feeding tube placement and discuss whether its failure may have played in the deterioration of this patient.

Question(s) For Expert Witness

1. Please describe your experience evaluating feeding tube placements in critical care-post trauma patients?

Expert Witness Response E-050232

As an interventional radiologist with 15+ years of experience at a leading university teaching hospital and medical center, I have been involved with the care of multiple trauma and critical care patients at our level 1 trauma center. In addition, I serve as the trauma liaison for radiology and participate in a monthly multidisciplinary trauma performance improvement committee as a representative for radiology. I have been involved in the evaluation, management, and placement of enteral access for over 15 years. These include all patient types, but particularly feeding tubes in critical care and trauma patients. I have published a poster on the topic of gastrostomy tube placement. I have lectured on interventional radiology management of feeding tubes and complications resulting from enterocutaneous fistulae. I have been exposed to patients who developed these outcomes and complications.