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Treatment of colon impaction led to perforation, plaintiff claims – Defense Verdict

Plaintiff, a female in her mid-fifties with a family history of cancer, was referred for colon cancer screening/ colonoscopy in July 2003. The procedure was terminated for fear of perforation. Barium enema was then recommended and performed the following day with noted findings of sigmoid diverticulosis and retained stool. Plaintiff presented to the emergency department two days later with complaints of constipation and right shoulder pain. She was without fever, and her initial white count was essentially normal.

She was admitted under the care of the defendant, a general surgeon, and his practice group. The cause of plaintiff’s pain was initially thought to be impacted barium in the colon. Treatment included use of soap suds enemas and oral cathartics; however, because her pain continued to worsen, a CT was performed during the early morning which revealed retained barium in the peritoneal cavity. Plaintiff was then immediately taken to the operating room where perforation of the sigmoid colon was noted. An exploratory laparotomy was performed resulting in resection of sigmoid colon with anastomosis, diverting colostomy, and removal of 95 percent of the barium. Postoperatively, plaintiff developed both sepsis and pulmonary edema, as well as upper lobe pneumonia. At the time of discharge, the pulmonary edema was noted to have resolved and tachycardia improved. Colostomy was still in place, and takedown was performed about two months later without complication. Plaintiff was ultimately referred to a plastic surgeon for concerns over abdominal scarring secondary to the earlier laparotomy, and a Fleur-de-lis abdominoplasty was performed.

Trial lasted three days and commenced June 27, 2012. Plaintiff’s standard of care expert testified that attempts to treat the impaction with soap suds enemas and oral cathartics were contraindicated, exacerbated a known serious situation, and led to the perforation. Defendants’ experts testified that immediate CT at the time of presentation would likely have been inconclusive due to the amount of retained barium, and that attempts to clean out the barium were appropriate. Further, the surgical pathology report was inconsistent with perforation at the time plaintiff presented to the emergency department.
On the third day of trial, the jury returned a verdict for the defendants.


Type of action: Medical malpractice
Type of injuries:  Perforation of sigmoid colon following colonoscopy and barium enema, resulting in surgical resection, colostomy, and cosmetic plastic surgery procedure.
Court: Shenandoah County Circuit Court
Tried before: Jury
Judge: Dennis Hupp
Special damages: $51,296
Demand: $1,700,000 (ad damnum)
Offer: None
Verdict or settlement: Defense verdict
Attorneys for defendants: Charles Y. Sipe, Charlottesville; S. Virginia Bondurant, Richmond
Attorney for plaintiff: Franklin B. Reynolds Jr., Washington
Defendants’ experts: Daniel Neumann, M.D., gastroenterology, Norfolk; David Peura, M.D., gastroenterology, Charlottesville; Marc Warner, M.D., general surgery; Richmond
Plaintiff’s experts:  Alvin Zfass, M.D., gastroenterology, Richmond

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