The case involves a 42-year-old man who presented to the hospital with abdominal pain and was found to have perforated appendicitis. He underwent laparoscopic appendectomy with drainage of abscess which he tolerated well. IR was consulted and attempted placement of drain however drain was placed within the cecum causing an iatrogenic perforation. The patient went back to the OR and underwent a robotic assisted right colectomy with lysis of adhesions and partial colectomy.
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Q: Information not adequate to make a determination on negligence. More information on IR involvement, such as timing after appendectomy, imaging report, procedure report, ect... I would need to see images of CT scans.
A: —
Do you believe there might have been medical error?
I would actually say 5.5. Have to see the CT scans to see if there was a residual collection, where the cecum was with respect to a collection, & where the catheter was placed.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Actually 5.5. Have to see the CT scans to see if there was a residual collection, where the cecum was with respect to a collection, & where the catheter was placed.
What makes you a good expert for this case?
Highly published interventional radiologist. Have published on drainage of appendiceal abscesses, complications of surgery, percutaneous cecostomy, catheters placed through bowel. Experienced as a medical malpractice expert.
How often do you encounter cases similar to this one in your practice?
It's not a common occurrence but have seen somewhat similar cases.
Do you believe there might have been medical error?
A drain should never end up in the cecum. CT guidance provides adequate anatomical visualization of an identified abscess and surrounding structures, avoiding peforation of a bowel wall. Even if the bowel wall was punctured by a needle, that should be identified immediately and a drain should not have been placed.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
A perforation of the cecum with the drain would result in the need for surgery.
What makes you a good expert for this case?
I perform CT guided drain procedures often within the hospital and outpatient setting. I am medical Director of Interventional Radiology. I have provided expert witness reports on a similar matter in the past.
How often do you encounter cases similar to this one in your practice?
Yes. we treat many patients who require CT drainage for abdominal abscess.
Do you believe there might have been medical error?
Appears that the drainage catheter was placed into the incorrect space under imaging guidance.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Appears that the drainage catheter was placed into the incorrect space under imaging guidance.
What makes you a good expert for this case?
I am an Interventional Radiologist with expertise in image-guided drainage procedures and would be happy to help.
How often do you encounter cases similar to this one in your practice?
Yes, have encountered similar cases.
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Comments are accepted only from Interventional Radiology and Diagnostic Radiology - includes all subspecialties experts.