Bowel perforation may have exacerbated existing problems – $1.65 Million Settlement

Plaintiff, 55, underwent a laparoscopic cholecystectomy. During the laparoscopy, defendant surgeon noted that a trocar may have perforated the small bowel. He looked for a perforation but did not find one. Defendant surgeon was concerned enough that he told his associates, including his co-defendant surgeon, that if plaintiff presented with complications following her discharge, they should consider a possible bowel perforation. The next day, plaintiff called the surgical group after she experienced persistent vomiting and severe pain. She was advised by defendant surgeon to go to the emergency room.

Plaintiff presented to the ER with an elevated white blood count. She rated her pain as an 8 out of 10. A CT scan showed an extensive amount of free and subcutaneous air as well as fluid in the area of the umbilicus – the same area where defendant surgeon expressed concern about a possible perforation. The radiologist who reviewed the CT scan reported that given the degree of free fluid and free air, bowel injury/perforation related to the recent surgery cannot be excluded, and that he suspected a small bowel obstruction. He also felt that there was an abscess forming in the right lower quadrant of plaintiff’s abdomen. Based on these findings, the emergency room physician started plaintiff on antibiotics and admitted her for observation.

These findings were reported to co-defendant surgeon, who was covering for defendant surgeon and undertook plaintiff’s care. Although he had been made aware of the potential for small bowel injury, and although he knew about the radiologist’s interpretation of the CT scan, and although he knew about plaintiff’s elevated WBC and abdominal pain, he reviewed the CT scan and decided plaintiff probably had a post-operative ileus.

Defendant surgeon was made aware of plaintiff’s re-admission and treatment plan the following morning. He did not question his junior colleague’s plan and did not see plaintiff again until several days later.

During the ensuing week, plaintiff experienced increasing edema in her abdomen and extremities. She experienced increasing abdominal pain and distention. Her WBC fell but she developed a fever. The defendants ruled out a bile leak but otherwise did not second-guess her treatment plan or otherwise take any action to rule out a bowel perforation until eight days after the laparoscopic procedure. Early in the morning on the eighth day following the procedure, plaintiff began leaking foul-smelling, bile-colored fluid from the surgical wound near her bellybutton.

Defendants performed an emergency exploratory laparotomy and located two bowel perforations, which they attempted to repair. Plaintiff subsequently underwent three additional laparotomies attempting to repair her bowel. She had an ostomy bag for months. At one point, her weight dropped from approximately 120 to 87 pounds. She required total parenteral nutrition. He had multiple PICC lines placed, one of which became infected, causing plaintiff to suffer septic shock and acute kidney injury. She suffers from short gut syndrome and is no longer a candidate for bowel surgery. She has frequent diarrhea and takes an array of pharmaceuticals to combat these symptoms. She takes medication to treat the side-effects of her medication.

Plaintiff had extensive pre-existing bowel issues, and may have been born with an abnormally short bowel. She suffered from irritable bowel syndrome and chronic anxiety. She had numerous preexisting bowel adhesions. She made many of the same complaints before and after the alleged malpractice, and there was significant dispute as to how much plaintiff’s condition had actually changed as a result of the alleged malpractice, and whether many of the repair procedures would have been inevitable given her preexisting bowel issues.

Defendants contested liability, but the main thrust of their defense was causation and damages, which were hotly contested by defense experts.

The case resolved through mediation requested by defendants.

[17-T-056]

Type of action: Medical Malpractice

Tried before: Mediation

Verdict or settlement: Settlement

Amount: $1,650,000

Attorneys for plaintiff: William B. Kilduff, Christopher L. Spinelli, and W. Randolph Robins Jr., Richmond