Mutual Matters

Don’t Complicate your Complication, a surgical complication case study

Posted by Marshaleen King, MD on Nov 30, 2017 1:00:00 PM

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Case Scenario

A 64-year-old woman presented to the emergency room (ER) with right sided abdominal pain. Her ER evaluation revealed cholelithiasis with thickening of the gall bladder wall. The patient was admitted by the surgical team on call and underwent laparoscopic cholecystectomy. 

Approximately 12 hours after surgery, the patient developed fever and tachycardia followed by tachypnea and abdominal rigidity. On evaluation by the surgical team, a decision was made to take her back to the operating room (OR) for an exploratory laparotomy. During her exploratory laparotomy the surgeon discovered a transection of her common bile duct and decided to perform a repair. The complication was addressed using a technique that included a choledochoduodenostomy.

Post-operatively, the patient developed septic shock complicated by multi-organ failure and her condition rapidly declined. On hospital day 4, the surgeon had a discussion with the patient’s family and a decision was made to transfer her to a tertiary care center. At the time of transfer, the patient was on mechanical ventilation and required several vasopressors to maintain her blood pressure. Following transfer to the tertiary care center, concerns were raised about breakdown of her common bile duct anastamosis. A second exploratory laparotomy was then performed, at which time she was noted to have separation of her choledochoduodenal anastomosis with leakage of bile and duodenal contents into the peritoneal cavity. A hepaticojejunostomy was then performed, along with placement of a gastrostomy-jejunostomy tube and percutaneous transhepatic cholangiography (PTC) drain. Following surgery, the patient recovered from severe sepsis but her renal failure persisted, warranting initiation of hemodialysis. In addition, she had difficulty being weaned from mechanical ventilation and had to undergo a tracheostomy.

The patient’s family was angry because they were not notified of the surgical complication until the option of transferring her to a tertiary facility was being considered. The family sued, stating that, 1) there was a delay in recognizing and appropriately treating her surgical complication, and 2) the delay in transferring the patient to the tertiary center resulted in her severe sepsis and renal failure. 

Read our patient safety discussion on this topic and learn how to possible avoid a medical malpractice claim by clicking below. 

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Topics: Patient Care and Interaction

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