Patient Dies of Sepsis After Colorectal Surgery

This case involves a 50-year-old male patient diagnosed with Stage III colon cancer. He had a colon resection performed by a colorectal surgeon. He was admitted to a Tennessee hospital for post-op observation over the weekend. Over the weekend, he began to experience intense pain. Nothing was done other than giving him pain medication until Monday morning when the surgeon saw him. After testing, it was determined that he had an anastomatic leak which had caused him to become septic and required surgical repair. That surgery was performed and he was never able to come off the ventilator following the surgery. He was transferred to another hospital and died a month later.

Question(s) For Expert Witness

1. How often do you treat patients with Stage III colon cancer?

2. What is the standard follow up for patients complaining of pain following colon resection surgery?

3. Can a delay in diagnosis of anastomatic leak worsen a patient's prognosis?

Expert Witness Response E-004735

I operate on about 20 patients with Stage III colon cancer a year, out of about 50 colorectal cancer procedures. The standard follow up for all patients after abdominal surgery consists of daily exams, monitoring of vital signs, and laboratory results. Should any issue come up, there are many other diagnostic modalities that can identify the problem. What you are describing here is unusual because most of the leaks after colorectal surgery occur later, possibly around day 5. Early leaks, like those around day 1, are caused by a major technical error of the surgeon. A delay in diagnosis of anastomotic leak has detrimental effects and worsens a patient's prognosis.