Case Archive
Ref. # 82908

An obese Indiana woman underwent a laparoscopic appendectomy for a ruptured appendix. Post-op she was hypotensive and returned to the OR for an exploratory laparotomy, which showed bleeding from the trocar site with rectus hematoma. The attending general surgeon then discovered the patient's family had a history of excessive bleeding, requiring Vitamin K prior to dental visits. Ten days later the patient's temperature was 102-103. A CT scan was concurrent with an abscess on the anterior wall. An interventional radiologist drained 230 cc of pus. Overnight the drain fell out and the umbilical trocar site leaked feculent material and barium. The collection at left midline improved with contrast term ileum right-sided leak. The patient required subsequent surgeries. A medQuest interventional radiologist opined more likely than not the attending radiologist did not cause the bowel fistula. However, the initial CT scans of the bowel were negligently under-opacified, increasing the risk of the subsequent drainage. As the contrast was not down near the umbilicus until 24 hours later, the injury probably occurred during the appendectomy, after which it walled off due to the patient's size. Potential liability existed for the attending general surgeon. The patient's complications were avoidable.

Ref. # 33758

A Pennsylvania woman suffered C-section complications including high fever, tenderness at the incision site, and high white blood cell count. An ultrasound was performed to locate the fever source; it revealed a small hematoma at the site of the incision and no abscess. Antibiotics were discontinued. The patient died two days later of septic shock; an autopsy performed was concurrent with myometrial abscess. A medQuest radiologist reported that the film quality of the ultrasound was insufficient to rule out the possibility of an abscess, as is generally the case. Standard of care required a CT scan to diagnose the unknown fever source. With appropriate treatment the patient would have survived.

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