Escolar Documentos
Profissional Documentos
Cultura Documentos
Home(https://www.theexpertinstitute.com/)/ExpertCaseStudies(https://www.theexpertinstitute.com/casestudies/)/
Fatalcolonoscopyduetobowelperforation
byFaizaPatten(https://www.theexpertinstitute.com/author/faiza/)February10,2014
(http://221yg6bkt0w1aj23k40l4jovwpengine.netdnassl.com/wp
content/uploads/2014/02/Colonoscopy.jpg) Thiscaseinvolvesahealthysixtytwoyearold
femalepatientwithnosignificantpastmedicalhistorywhopresentedtoamedicalfacilityfora
routine colonoscopy(https://www.theexpertinstitute.com/expertwitness/colonoscopy/)
toremovepolyps.Shewasdischargedshortlyaftertheprocedure.Shereturnedtothemedical
centersemergencydepartmentaccompaniedbyherdaughteraroundtwohourslater
complainingofheavybleedingfromherrectumandsevereabdominalpain.Whilewaitingtobe
seenintheERshewenttousetherestroom.Whenshedidnotreturntothewaitingareaafter
alongperiodoftimeherdaughterwenttolookforher.Shewasfoundunconsciousina
cubicle,inapoolofblood.Shewasrushedfromtriageimmediately,atwhichtimeasigmoidoscopywasperformed,withclipsplacedin
theareawherepolypshavebeenpreviouslyremoved.Aftertheprocedurethepatientcontinuedtohavesymptomsofabdominalpain
andshowedsignsofadistendedabdomen.A CTscan(https://www.theexpertinstitute.com/expertwitness/ctscan/) wasordered
toinvestigatethepersistentabdominalsymptomsbutitwasnotreaduntilfourhourslater.Fourhourslater antibiotics
(https://www.theexpertinstitute.com/expertwitness/antibiotics/) wereadministeredforasuspectedsurgeryrelated infection
(https://www.theexpertinstitute.com/expertwitness/infection/) .Oncethesurgeoninchargeofthispatientscarewasmadeaware
oftheevolvingdetailsthedecisionwasmadetoperformanexploratorylaparotomy.Theteamfounda perforation
(https://www.theexpertinstitute.com/expertwitness/perforation/) ofabout1cm,andalargedoseofantibioticswasadministered
intraoperatively.Thepatientsdeterioratedpostoperativelyasthestaffhaddifficultymaintainingthepatientsbloodpressurewithina
normalrange.Thepatientpassedawaywithinafewhoursofthelaparotomy.
QUESTION(S)FOREXPERTWITNESS
Whatisthestandardprocedureintheadministrationofantibioticstoremedythesituationofsepticshockfrombowel
perforation?Wasthetimingoftheemergencysurgerywithinthestandardofcare?Wasthereafailuretomonitorher
haemoglobinandhaematocritlevelstomaintainthepatientsbloodpressurefollowingthelaparotomy?
EXPERTWITNESSRESPONSEE007288
(https://www.theexpertinstitute.com/expert/emergencysurgerytraumaandcriticalcareexpertwitnesse
007288/)
EXPERTID:E007288
(HTTPS://WWW.THEEXPE
Thesurvivingsepsisguidelines(DellingerRP,etal.CritCareMed.2013Feb41(2):580637)statethatbroadspectrumantibiotics
RTINSTITUTE.COM/EXPE
RT/EMERGENCY
shouldbeadministeredwithin3hoursofpresentationtotheemergencydepartmentorwithinonehourofadmissiontoanintensive
SURGERYTRAUMA
careunitoncesepsishasbeensuspected.Ifadiagnosisofperforatedviscuswithsepticshockwasmade,operationshouldbe
ANDCRITICALCARE
EXPERTWITNESSE
performedassoonasanoperatingroomisavailable.However,ifthediagnosiswashemorrhagicshock(andperforatedviscuswas
007288/)
onlydiagnosedatthetimeofoperation)thenmultipleadjunctscanbetriedoncethepatienthasbeenresuscitatedappropriatelysuch
https://www.theexpertinstitute.com/casestudies/fatalcolonoscopyduetobowelperforation/ 1/6
2/11/2017 Fatalcolonoscopyduetobowelperforation
asendoscopicmanagementofthebleedingsourceorangiographiccontrolofthebleedingsource.Operationisreservedforfailureof
endoscopyandangiographyinthesettingofGIbleeding.Inthesettingofactive,ongoingbleeding,haemoglobinandhaematocrit
alongwithcoagulationparametersshouldbemeasuredevery46hoursataminimumusuallymorefrequentlyastheyarechecked
periodicallyaftertheadministrationofcomponenttransfusiontherapy.
REQUESTEXPERTE007288
RELATEDEXPERTWITNESSES
https://www.theexpertinstitute.com/casestudies/fatalcolonoscopyduetobowelperforation/ 2/6
2/11/2017 Fatalcolonoscopyduetobowelperforation
https://www.theexpertinstitute.com/casestudies/fatalcolonoscopyduetobowelperforation/ 3/6
2/11/2017 Fatalcolonoscopyduetobowelperforation
POSTTAGS
AbdominalPain(https://www.theexpertinstitute.com/expertwitness/abdominalpain/)
BowelPerforation(https://www.theexpertinstitute.com/expertwitness/bowelperforation/)
Colonoscopy(https://www.theexpertinstitute.com/expertwitness/colonoscopy/) Medical(https://www.theexpertinstitute.com/expertwitness/medical/)
MedicalMalpractice(https://www.theexpertinstitute.com/expertwitness/medicalmalpractice/) Pain(https://www.theexpertinstitute.com/expertwitness/pain/)
Proctology(https://www.theexpertinstitute.com/expertwitness/proctology/)
RELATEDPOSTS
Generalsurgeryexpertwitnessopinesonlaparoscopicsigmoidectomy
ComplicationsofLaparoscopicandRoboticSurgery
PatientContractsFatalAbdominalInfectionDuringColonSurgery
PEGTubeCausesSepsisandEarlyDeath
Voted#1ExpertWitnessProviderof2016By:
https://www.theexpertinstitute.com/casestudies/fatalcolonoscopyduetobowelperforation/ 4/6
2/11/2017 Fatalcolonoscopyduetobowelperforation
https://www.theexpertinstitute.com/casestudies/fatalcolonoscopyduetobowelperforation/ 5/6
2/11/2017 Fatalcolonoscopyduetobowelperforation
https://www.theexpertinstitute.com/casestudies/fatalcolonoscopyduetobowelperforation/ 6/6