Colonoscopy resulting in splenic capsule laceration and death (Case #243)

• Medical Probability: 6 / 10
• Medical Error Summary: The cause of a splenic injury on a colonoscopy is most commonly looping of the scope. Keeping the scope straight reduces this risk. It is more challenging to keep the scope straight when the bowel pr...
• Causation Probability: 6 / 10
• Causation Summary: As stated above, with the inadequate prep, it is difficult to keep the scope straight and results in looping which can put pressure on the spleen
• Expert Summary: I am an academic gastroenterologist and have experience with colonoscopy and teaching fellows colonoscopy.
• Similar Summary: This is a rare complication of a colonoscopy but certainly one that has been described in the literature

Missed Polyp (Case #322)

• Medical Probability: 6 / 10
• Medical Error Summary: Colonoscopy is our best test for polyp detection and colon cancer detection but it is not perfect. Interval colon cancers have been well described in the literature and are presumed to be related to ...
• Causation Probability: 3 / 10
• Causation Summary: Polyps do not generally cause obstruction in the large intestine and unlikely to have caused obstruction at that size. One could easily argue that the obstruction was not related to this polyp and it...
• Expert Summary: I am a gastroenterologist and routinely perform screening colonoscopies with polypectomies and refer patients for surgery if indicated. I review about 8-10 cases a month for an expert witness company...
• Similar Summary: This is an unusual situation. I deal with large polyps that may require surgery but have not encountered a case where a missed polyp was attributed to post op obstruction.

23 year old male requiring complete colon resection after chronic colitis. (Case #346)

• Medical Probability: 7 / 10
• Medical Error Summary: The standard of care for management of patients with acute severe ulcerative colitis requires close monitoring of response in the inpatient setting. Typically this involves starting intravenous, stero...
• Causation Probability: 7 / 10
• Causation Summary: This patient more likely than not was going to need surgery given the inadequate response to both IV steroids and Remicade. That being said, this likely could’ve been recognized sooner and done on ...
• Expert Summary: I have additional training in inflammatory bowel disease and regularly treat IBD in my practice using conventional therapies, biologic therapies, small molecules, and then refractory cases surgical re...
• Similar Summary: I frequently see ulcerative colitis, which is refractory to medical therapy and requires surgery. These patients are often seen in the hospital or sent to the hospital for acute severe ulcerative coli...

74yo F splenic laceration during a colonoscopy with polypectomy (Case #481)

• Medical Probability: 3 / 10
• Medical Error Summary: The spleen sits in close proximity to the colon and can be injured during a colonoscopy. It is a less common but well described risk of colonoscopy and can occur due to scope moving around the splenic...
• Causation Probability: 3 / 10
• Causation Summary: As above, this is a known complication of colonoscopy, and one that is not typically apparent during the time of the colonoscopy or recovery
• Expert Summary: I have reviewed other similar cases involving injury to the spleen due to colonoscopy
• Similar Summary: I have not seen them in my personal practice, but have been consulted by other attorneys to review other similar cases

Internal bleed resulting in death (Case #489)

• Medical Probability: 6 / 10
• Medical Error Summary: A visible vessel requires treatment with clips or cautery. Epinephrine is used to slow down bleeding so that the bleeding site can be visualized and treated. Hemostatic sprays can be used with activ...
• Causation Probability: 9 / 10
• Causation Summary: The presence of a visible vessel makes releasing a significant risk. The failure to adequately treat the visible vessel likely led to rebleeding and her death
• Expert Summary: I am a practicing gastroenterologist seeing patients both inpatient and outpatient. Upper GI bleeding due to peptic ulcer disease is a routine consult seen on any inpatient GI service and have treate...
• Similar Summary: I cover the inpatient service about four times a year and routinely see upper GI bleeding. Some of these ulcers heal with just PPI therapy but many require therapy with clips or cautery and if refrac...

Failure to diagnosis perforation in sigmoid colon leading to extensive leakage of fecal matter into abdominal and requiring surgery. (Case #512)

• Medical Probability: 2 / 10
• Medical Error Summary: Acute uncomplicated diverticulitis meaning no perforation or abscess can be trialed with oral antibiotics. It does not require GI or surgical consultation
• Causation Probability: 2 / 10
• Causation Summary: As above, the initial presentation was negative and was appropriately managed with antibiotics and instructions to return
• Expert Summary: I regularly see patients with diverticulitis
• Similar Summary: I see patients with diverticulitis a few times a month