A continuing problem affecting patients who undergo common surgeries is the delay in diagnosis and treatment of iatrogenic bowel perforation as a result of the surgery. Iatrogenic is the term used to describe injury that occurs during the course of medical treatment. Many types of intra-abdominal surgery may place a patient at risk for bowel perforation. However, failure to diagnose and repair the injury promptly is medical malpractice, and may result in significant permanent injury or death.
Examples of Bowel Perforation
The medical literature is filled with examples of bowel perforation errors caused during surgery. One case reported in the medical literature described a 46-year-old woman who underwent elective surgery to release tissue adhesions. The iatrogenic perforation was not noticed before the surgery was completed. The patient began to complain of pain the second day after surgery.
Some symptoms of perforation after abdominal surgery include increasing pain, vomiting, distension of the abdomen, and inability to pass urine or gas. There are also signs that indicate perforation has allowed peritonitis to set in, and these signs include signs similar to all serious infections – rapid heart rate, fever, dehydration, and low urine output. Signs specific to an intra-abdominal process include an absence of bowel sounds and tenderness to palpation of the abdomen.
The surgeon in this case ordered a series of abdominal x-rays, but drew no conclusion from the studies, and prescribed pain medication as the patient’s condition deteriorated. The definitive response to evidence of bowel perforation and rapid deterioration in the patient’s condition after intra abdominal surgery is an exploratory laparotomy. The perforation must be repaired, and the abdominal cavity must be thoroughly decontaminated.
Unfortunately, sometimes a physician sees their post-surgical patients only once daily. They write orders in the morning on rounds, and typically get the results the next day. In smaller hospitals, where the surgeon may be the only physician caring for the patient, this can present significant risks.
A young girl in Mississippi was scheduled for an elective iliostomy for treatment of Crohn’s disease. After surgery, the surgeon in the local hospital signed out for the day, and when he saw her the next morning, she was having difficulty managing her abdominal pain. Typically post-surgical patients do experience some pain, which is easily controlled with medication. However, the pain of peritonitis is severe, and is characterized by its progression.
Despite changes in her vital signs that indicated she most likely had an infectious process going on, the surgeon failed to consider the most damaging possibilities. Instead, he sent off for chest x-rays and a urinalysis, failing to acknowledge that her signs and symptoms pointed to something much more serious than a catheter acquired urinary tract infection or a pulmonary infection as a result of not fully expanding her lungs post operatively.
This surgeon also allowed the patient’s condition to deteriorate for several days, during which he opted for “conservative management.” Sometimes conservative management means appropriately waiting for a disease process to declare itself, but in the case of a bowel perforation and significant deterioration in the patient’s status, conservative management has no role in the treatment plan. A surgeon should never let the sun set on a suspected bowel perforation. If there is any doubt, the experienced surgeon knows that an exploratory laparotomy may be not only diagnostic, but also life saving.
In both of these cases, the patient’s condition deteriorated to multi-organ failure. The mortality rate of multi-organ failure ranges from 26% to 88%, depending upon the number of critical body systems that fail. Both patients died after many days in the intensive care unit, receiving too little care too late.
These were avoidable deaths. If you or a family member has experienced a failure to diagnose a bowel perforation after surgery or even after a colonoscopy, you may have been the victim of medical malpractice.
Contact Passen Law Group’s top-rated medical malpractice attorneys at 312-527-4500 for a free consultation regarding your case.