Case Report: Failure to diagnose and treat volvulus
(Excerpts taken with permission from Minnesota Trial Lawyer Association's (MTLA) "Minnesota Case Reports")
Jane Doe, age 62, presented to the emergency room with sudden onset of severe abdominal pain and vomiting. Abdominal films showed significant dilatation of the cecum suggestive of ileus (temporary absence of the normal contractile movements of the intestinal wall.) CT scans of the colon showed evidence of both ileus and mechanical obstruction (mechanical obstruction can lead to rupture).
Defendant surgeon examined Jane Doe and reviewed the radiology report from the abdominal films. Because the CT report was not yet dictated, the surgeon met with the radiologist who had interpreted the CT scans. At his deposition, the surgeon testified that the radiologist told him that although a gastrograffin enema study could be done to rule out a mechanical obstruction, the radiologist strongly advised against the study because Jane Doe likely had pseudo-obstruction and the study could cause her colon to perforate. The surgeon then admitted Jane Doe to the hospital and ordered suppositories and fleet enemas with a plan to do a gastrograffin enema study the next day if Doe did not improve.
After meeting with the surgeon, the radiologist who had reviewed the CT scans dictated his report. His report stated that he could not rule out mechanical obstruction and recommended a gastrograffin enema study to rule out mechanical obstruction if clinically indicated.
Doe continued to deteriorate overnight and early the next afternoon a gastrograffin enema study was done. This study confirmed the presence of a sigmoid volvulus. By the time Doe reached the surgical suite, she was in extremis (term which defines condition prior to death). The surgeon found both a cecal and sigmoid volvulus and had to remove significant segments of both large and small bowel which had become necrotic. A colostomy was placed. Since then, Doe has undergone multiple surgical procedures for ongoing infections and obstructions and is permanently and severely disabled.
After suit was commenced and after the deposition of the surgeon was taken, the radiologist was deposed. He disputed the surgeon’s recollection of their conversation and went through the CT images, chapter and verse, to explain why he never would have advised against a gastrograffin enema study on the day of admission. He said he was ready, willing, and able to do the study at the time he met with the defendant surgeon.
The defendant surgeon and his surgical group continued to defend this case until eight weeks before trial. They did so, even though they apparently could not find an independent expert to defend the conduct of the defendant surgeon. The defendant surgeon, and his colleague who had performed the surgery on the second day of the admission, provided the only expert disclosures for the defense.
Settlement: $2 million (policy limits)
Case Name: Jane Doe v. Surgeon and Surgical Group
Date of Disposition: July, 2006
Attorneys: John F. Eisberg
William J. Maddix