Patient Requires Complete Colon Removal Following Delayed Surgical Intervention

This case involves a 65-year-old female with a complicated past history who was diagnosed with a colon adenocarcinoma. The patient had the adenocarcinoma removed laparoscopically and her post-surgical margins were clean. While in the hospital, the patient experienced an elevated white blood cell count as well as abdominal pain. Several imaging studies were conducted on the patient. The results demonstrated free air in the abdomen but the patient was not taken back for exploration. 18 days after the initial surgery, the patient returned to the hospital with severe abdominal pain and night sweats. She returned to the operating room and it was determined that the patient’s entire colon required removal. It was alleged that the delay in post-surgical treatment caused the patient’s unfortunate prognosis.

Question(s) For Expert Witness

1. How often do you operate on patients with adenocarcinoma of the colon?

2. When are post-operative imaging studies recommended and what are absolute indications for a RTOR?

Expert Witness Response E-006633

I have been in practice as a colorectal surgeon for 13+ years. I have been the residency director at my hospital for 11 years and I have trained colon and rectal residents my entire career. I am very familiar with the standard of care in colorectal surgery, given my involvement in training as well as sitting on the Residency Review Committee of the ACGME. In addition to being a board member of the American Board of Colon and Rectal Surgery, I am also a full professor at a large university on the west coast. I operate on patients with colon cancer weekly. Generally, at a minimum, I handle three cases per week involving colon cancer. The decision to conduct postoperative imaging and return to the operating room are clinical judgments that are difficult to state in absolute terms. Usually, there are clinical indicators that are present to dictate whether imaging or operation is necessary. These signs include vital signs, trending of labs, exam findings, other indicators that there is something that requires further intervention. Persistent fever, up-trending of the WBC count, worsening physical exam signs, failure to progress after surgery, etc. are all signs. I have reviewed similar cases involving leaks and postoperative complications and have given depositions as well as trial testimony (both in state and federal system).