EGD/MI (Case #271)

• Medical Probability: 4 / 10
• Medical Error Summary: It appears standards of cares were followed by the providers with the information they had at the time of making decisions.
• Causation Probability: 3 / 10
• Causation Summary: It is difficult to establish causality from non-specific and changing signs and symptoms.
• Expert Summary: Gastroenterologist x 9 years practicing in outpatient and inpatient setting with anesthesia providers providing sedation.
• Similar Summary: Rarely have I encountered acute coronary syndrome in the setting of outpatient endoscopy.

Delayed diagnosis of colon cancer with signet ring cell features (Case #275)

• Medical Probability: 2 / 10
• Medical Error Summary: Signet cell carcinoma of the colon is extremely rare (about 1%). It is also not the type of cancer in the colon that screening programs (colonoscopy, fecalimmunochemical tests [FIT], or Cologaurd) f...
• Causation Probability: 1 / 10
• Causation Summary: Colon cancer screening is not designed for signet cell cancer. This signet cell may have been metastatic from another organ (stomach).
• Expert Summary: I am a practicing gastroenterologist over 10 years with active colon cancer screening program.
• Similar Summary: I have never seen signet cell carcinoma in the colon.

Death due to hypotensive shock, severe blood loss, and acute GI bleed. (Case #296)

• Medical Probability: 8 / 10
• Medical Error Summary: 79 y/o patient with DM, signs and symptoms of overt gastrointestinal bleeding, and upper endoscopy revealing duodenal ulcer with pigmented lesion not treated endoscopically. The described lesion sugg...
• Causation Probability: 8 / 10
• Causation Summary: Failure/delay to recognize active acute gastrointestinal bleeding and patient decompensating. Failure/delay to escalate care or concerns. CT angiogram could have been ordered to look for activ...
• Expert Summary: I have been a practicing gastroenterologist treating GI bleeding in level 4 trauma hospitals in the Texas Medical Center for ten years.
• Similar Summary: I encounter cases similar to this one weekly.

Missed Polyp (Case #322)

• Medical Probability: 8 / 10
• Medical Error Summary: 1. Was it reasonable for the GI MD to fail to identify the polyp during the colonoscopy which was ultimately described as 2.6 x 2.0 x 1.4 cm? In other words under the circumstances of this case, did h...
• Causation Probability: 8 / 10
• Causation Summary: First, the colonoscopy report appears to be missing essential information, specifically extent of exam with mucosal description proximal to the mass. Second, why was a division point selected 8cm p...
• Expert Summary: I have ten years experience as a gastroenterologist in the Texas medical center. I specialize in colon cancer screening. I am a member of quality review for adverse events and m&m related to endosco...
• Similar Summary: Communication related medical errors are not uncommon. I have not ever encountered this case specific chain of events.

Death After Bowel Obstruction (Case #345)

• Medical Probability: 9 / 10
• Medical Error Summary: It appears a bowel obstruction lead to ischemic bowel, sepsis, and death. The patient was it increased risk for bowel obstruction which the wife who visits the patient multiple times per week pointed...
• Causation Probability: 9 / 10
• Causation Summary: The patient was clinically worsening with fluctuating bowel sounds 6/6/23. Unclear if an abdominal exam was performed on 6/7/23. An ishcemic bowel obstruction with suspected aspiration pneumonia an...
• Expert Summary: I have worked in the inpatient and outpatient settings as a gastroenterologist in the Texas Medical Center for 10 years.
• Similar Summary: I see a case similar to this one on a monthly basis in our tertiary care level 1 trauma center hospitals.

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

• Medical Probability: 8 / 10
• Medical Error Summary: The case describes a 23 y/o patient with hematochezia and endoscopy revealing pan colitis. It appears the physician was appropriately working up infectious colitis and inflammatory bowel disease. T...
• Causation Probability: 9 / 10
• Causation Summary: Yes. It appears the diagnosis was missed or under treated. Specifically an infectious cause of colitis may have been missed (the case details did not include). If the patient had suspected severe i...
• Expert Summary: I am a GI provider in the texas medical center tertiary care hospitals for 10 years. I have treated numerous infectious and severe inflammatory bowel disease patients in the inpatient and outpatient ...
• Similar Summary: I see patients with inflammatory bowel disease weekly and encounter similar cases of severe colitis on a monthly basis.