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leading to massive infection, Wrongful Death
The decedent was a 63-year-old woman who underwent elective lumbar spine surgery. The general surgeon described the procedure as difficult due to her body mass index, and the presence of significant adhesions.
The day after her procedure, the patient had an increased heart rate and lower blood pressure. These symptoms carried over into the second day after her operation. On the second evening, she was resuscitated with IV fluids which somewhat improved her hypotension.
The following day, an abdominal CT scan was ordered, which, according to the radiologist, demonstrated several issues. There was a thickening of her colon wall and a collection of fluid in her intra-abdominal cavity. At the time of the CT scan, the decedent’s hypotension had normalized without intervention and her increased heart rate had resolved. She was described as alert, friendly, and interactive. Multiple abdominal examinations revealed a soft, non-tender, nondistended abdomen with positive bowel sounds. Her hypotension was thought to be secondary to an acute kidney injury.
The defendant, her treating general surgeon, reviewed the abdominal CT scan and made a conclusion that the fluid demonstrated on the film was not from a colon leak, but more likely represented post-surgical fluid typical of the procedure the patient had undergone. As a result of this conclusion, no exploratory laparotomy or serial abdominal imaging was ordered at that time. Lab values from a complete blood count showed an elevated white count of 14.8. The patient’s pre-operative white count was 12.8 and her white count on post-op day 1 was 10.8.
On the evening of post-op day 3, she was experiencing an altered mental status. The following day, the neurosurgery team was called to her bedside due to her increased respiratory effort. She was transferred to the ICU. On post-op day 4, another abdominal CT scan was ordered. It displayed the continued thickening of her sigmoid colon, with free air and the leakage of rectal contrast dye into the surrounding tissue.
An exploratory laparotomy was performed, and stool was identified behind the abdominal cavity. There was also a colonic perforation, which was repaired. Tissue from the colon was sent to pathology, and an analysis diagnosed the issue as “sigmoid colon, resection – perforated acute diverticulitis.”
The plaintiff alleged that the decedent’s sigmoid colon was perforated by the general surgeon during the procedure, likely due to the difficulty of the dissection. The plaintiff also alleged that although a colonic injury was a risk of the procedure, the defendant’s failure to appropriately respond to the initial CT scan was a breach of the standard of care. The plaintiff also alleged that by failing to promptly return the patient to surgery, it allowed her intra-abdominal infection to worsen. This caused her to become septic and die, despite having undergone the laparotomy on post-op day 4.
The defense argued that during her postoperative course, the decedent had been improving and never demonstrated any clinical signs that indicated the need for a surgical intervention. They added that even if there were an infectious process underway, her poor baseline health as a result of uncontrolled type-2 diabetes would have prevented her from resolving an intra-abdominal infection. The defense also challenged the mechanism of the bowel perforation, arguing that the bowel had perforated at some point after the spine surgery as a result of acute diverticulitis.
This medical malpractice case was settled out of court for $900,000.
Attorneys for the plaintiff:
- Derrick L. Walker, Richmond,
- Malcolm McConnell, Richmond
- Kari La Fratta, Charlottesville