2/11/2017 Fatalcolonoscopyduetobowelperforation

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Fatalcolonoscopyduetobowelperforation
byFaizaPatten(https://www.theexpertinstitute.com/author/faiza/)February10,2014

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(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

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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/)

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