Perforated Colon During Routine Procedure Leads to Sepsis

The patient is a 68-year-old male who presented with an intestinal obstruction that required surgical intervention. The patient was examined and the diagnosis of small bowel obstruction was suspected and preparations for colonoscopy were made. The procedure was noted to be simple and uncomplicated and a total of 14 polyp resections were noted in the chart, the polyps were between 3-4 mm in size. The procedure lasted approximately 25 minutes. The patient complained of abdominal pain following the procedure and the patient was examined and the abdomen was described to be soft, non-tender and non-distended. He was cleared for discharge and told to contact the doctor if any fever or chills persisted. The patient was later brought to the ER in excruciating pain. Abdominal imaging studies reveal that a perforation was spilling fecal contaminants into his abdomen. The patient developed sepsis and died shortly after the surgery to repair the perforated colon.

Question(s) For Expert Witness

1. Does this case have merit and was it the physician's responsibility to recognize the perforation before it evolved from an abdominal infection into full-blown sepsis?

Expert Witness Response E-000090

When patients call in with pain after a colonoscopy, the burden of proof is on the doctor to make sure that there was no perforation. Perforation is a well-known and highly dangerous potential complication in virtually every surgical procedure executed around the bowels. It is imperative that any potential nicks or injuries to the bowel be detected and repaired before closing the patient. If a perforation does somehow evade detection, it is important that any symptoms of infection or sepsis that the patient develops be investigated aggressively. In this case, it seems that both the operating physicians and the doctors who cleared the patient for discharge were at fault, although timing may be a factor in whether an aggressive investigation of the patient's initial pain was warranted. Regardless, the patient would likely have had a more favorable outcome had the perforation been detected and repaired earlier.