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Woman chose colon stent, suffered bowel perforation – Defense verdict

Plaintiff originally came to see the defendant gastroenterologist for a GI consult on March 17, 2009. Her complaint at the time was frequent diarrhea, although she had recently finished taking an antibiotic (Augmentin) for a sinus infection in December 2008. At the time of her appointment with the defendant, her diarrhea symptoms had stopped. Defendant physician concluded that she had suffered diarrhea that was related to the antibiotics that she had been taking. Due to the fact that it had resolved spontaneously, he did not advise any further action be taken at that time. He indicated that she should return to see him should the symptoms recur.  Plaintiff’s diarrhea symptoms did reoccur and she returned to defendant’s office on May 21, 2009. At the conclusion of this visit, defendant recommended that a colonoscopy be performed to find out what was causing the diarrhea, and to rule out any chance of colorectal cancer.

On June 23, 2009, plaintiff had difficulty drinking the prep material prior to the colonoscopy and became nauseated and vomited. She presented to the endoscopy suit at defendant’s request and was given Demerol for her pain which allowed her to drink more of the prep material. The colonoscopy was then performed. During the colonoscopy, defendant ran into a stricture, or stenosis (a clamping down of a portion of the colon caused by endometriosis), in the distal sigmoid colon. He could not get past the obstruction with his adult colonoscope, and therefore, switched to a pediatric, or narrower, colonoscope. He was able to get through the stenosis with the pediatric colonoscope, but quickly aborted the procedure due to the fact that her abdomen became hard, and defendant suspected a possible perforation. Plaintiff was admitted to the Winchester Medical Center, and he ordered abdominal x-rays, as well as a CT scan. The x-rays and CT scan indicated no evidence of a bowel perforation. However, it did indicate that she was severely distended due to the blockage, and therefore, was at an increased risk of a perforation.

Following the results of the CT scan, defendant had a discussion with the plaintiff and informed her that she had a colon blockage and that this was a surgical issue and he would refer her for a surgical consult. Plaintiff, who was 29 at the time, was very adamant about refusing to have surgery that would leave her with a temporary colostomy. She was thereafter told by the surgeon that she had two alternatives to decompress her colon: surgical resection with a temporary colostomy, or a stent placement followed by surgical resection without a colostomy (assuming the colon stent was successful). She ultimately chose the colon stent option.

On June 25, 2009, defendant performed the stenting procedure under fluoroscopic guidance.  For a short period of time after the stent placement, it readily appeared that she was decompressing nicely and passing stool, and defendant proceeded to start a planned colonoscopy on another patient. About 20-30 minutes following the stent placement, the patient started crashing as her blood pressure dropped precipitously, and a great deal of resuscitation was necessary to get her stabilized, intubated and transferred to the ICU. Plaintiff was ultimately found to have suffered a colon perforation following the stent placement, and she went on to develop abdominal compartment syndrome, sepsis, renal failure, liver failure, respiratory distress syndrome and a brain bleed which ultimately required a craniotomy procedure (removal of a portion of the skull to allow the brain to expand). She was placed into a medically induced coma for several weeks.

Ultimately, plaintiff also had a double resection surgery and a temporary colostomy to take out the obstruction and perforation in her bowel, and since her release from the ICU, she underwent extensive outpatient rehabilitation which included speech therapy and physical therapy to learn to walk, talk and function.

Since her release from the hospital, she has recuperated, and was ultimately able to return to work, but at a different job requiring less hours and less stress.

Plaintiff claimed that defendant was negligent by failing to order an x-ray or CT on the morning of June 23 before having her drink more of the prep material and by going forward with the colonoscopy and the stent placement procedure two days later. Plaintiff alleged she was too distended to attempt said procedures, and that they collectively caused the perforation because additional air had to be used in order to perform the colonoscopy and place the stent. Defendant claimed that the colonoscopy was necessary to fully diagnose the problem, and that the plaintiff chose the stenting procedure after a full discussion of the risks involved to potentially avoid a colostomy.

The jury deliberated approximately four hours before returning a defense verdict.


Type of action: Medical malpractice
Injuries alleged: Perforated colon, abdominal compartment syndrome, sepsis, aspiration pneumonia, thrombocytopenia, brain bleed, craniotomy, renal failure, liver failure
Name of case: Boehmler v. Sears
Court: Frederick County Circuit Court
Case no.: CL11-218
Tried before: Jury
Date: July 18, 2012
Demand: $5,000,000
Offer: None
Verdict or Settlement: Defense verdict
Attorneys for defendant: Stephen Altman and Marc A. Brown, Fairfax
Defendant’s experts: John Kuemmerle Jr., M.D.; David Beck, M.D.; Donald Colvin, M.D.; Barry Daly, M.D.; Phillip Buescher, M.D.
Plaintiff’s experts: Michael D. Apstein, M.D., FACG; Todd D. Eisner, M.D.; Blaine Nease, M.D.

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