Case Archive
General Surgery
Ref. # 56048

A middle-aged Pennsylvania woman was admitted to the ER after a sudden onset of abdominal pain. Only an abdominal exam was performed; there was no pelvic or rectal exam, no labwork, and no observation for deterioration of the condition. The woman was diagnosed with muscle strain and discharged. She returned several hours later in full arrest; resuscitation was unsuccessful. An autopsy revealed peritonitis due to a perforated duodenal ulcer. The attorney questioned if an early diagnosis and subsequent treatment would have substantially increased the likelihood of the woman's survival. A medQuest general surgeon opined that the initial physical exam was incomplete and, with lack of blood work, below standard of care in light of tenderness on the abdominal exam. The expert further reported that the patient would have required hospital admittance and surgery ten hours prior to the arrest with a significant chance for a better outcome.

General Surgery
Ref. # 02618

A 64 year old Texas woman underwent a laparoscopic cholecystectomy, during which the common bile duct and gall bladder were found to be severely inflamed. The bile duct was clipped and transected. The patient subsequently required additional surgeries. A medQuest general surgeon opined the attending surgeon negligently failed to convert to an open procedure or perform an intra-op Cholangiogram. The patient's complications were avoidable.

General Surgery
Ref. # 63218

A 44-year-old North Carolina woman with a history of thrombotic posterior circulation stroke and a suboccipital craniotomy for decompression underwent excision of an ingrown toenail. The patient was examined six times during the next three weeks. She complained of pain and discoloration at these exams; the general surgeon stated her condition was improving. One week after the last exam she presented to the ER with decreased circulation in the right leg and foot. The diagnosis was impending gangrene of the right toe with infected paronychia, and new adult onset diabetes mellitus. The patient was transferred to a major medical center, where treatment with heparin, then coumadin, was unsuccessful. The patient underwent a right femoral-to-posterior tibial bypass with reverse saphenous vein graft. She did not do well post-op and required a below-the-knee amputation five days later. A medQuest general surgeon reported that, prior to the toenail excision, there was a negligent failure to perform pre-op vascular tests to establish adequate blood flow to the foot. Post-op care required similar testing or referral to a vascular surgeon or lab. The delay in treatment contributed to the loss of the patient's foot.

General Surgery
Ref. # 97397

A Wisconsin woman underwent a laparoscopic cholecystectomy. Two days after discharge and four days post-surgery, she was nauseous, so she saw the surgeon at his clinic. Three days later the patient returned to the hospital with severe abdominal pain. Exploratory surgery confirmed that the common bile duct had been terminated by a surgical clip. The patient was transferred to a major medical center, where she underwent several corrective procedures including major biliary reconstruction. A medQuest general surgeon reported the gall bladder surgery was performed negligently. If there was, as was documented, so much edema that the anatomy was obscured, standard of care required opening up the patient or performing a cholangiogram to clearly delineate the anatomy. The attending surgeon failed to recognize the common bile duct was transected during the procedure, which lasted only 30-35 minutes. Standard of care requires a careful, deliberate dissection, but in this case the surgeon opened too quickly in an acutely inflamed, poorly delineated anatomy. The patient's complications were avoidable.

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