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  4.  | A Punch Biopsy of the Liver during a Diagnostic Laparoscopy Results in a Man’s Internal Bleeding and Untimely Death

A Punch Biopsy of the Liver during a Diagnostic Laparoscopy Results in a Man’s Internal Bleeding and Untimely Death

Our client was a 55 year old man who enjoyed spending time with his family, tending to his cattle, and working at his job in construction. He was a family man to the core and enjoyed having his whole family together every Sunday afternoon. One day, he reported to the emergency room complaining of fever, chest pressure, and a rapid heartbeat for the past four days. Blood work indicated an infections process and a urinalysis indicated a urinary tract infection as well as a critical platelet count of 44,000. Further examination by nursing staff revealed complaints of nausea, vomiting, abdominal pain, decrease in urinary output, and a headache.

A CT scan was performed on our client. The radiologists who interpreted his CT scan suspected acute appendicitis and stated that pyelonephritis should also be considered. He was treated with intravenous antibiotics and fluids. The emergency department of the small hospital that our client went to could not adequately treat him, and they obtained acceptance for a transfer to a larger hospital that had a general surgeon available. The larger hospital received our client under the care of a general surgeon for the diagnosis of acute appendicitis, urinary tract infection, and gastroenteritis. At the time of transfer, he had a high temperature and a critical platelet count of 44,000 (normal platelet counts for this man should be between 150,000 and 450,000). A few hours later his platelet count had fallen to 34,000, and the general surgeon decided to perform and diagnostic laparoscopy on our client. During the procedure, the surgeon removed the appendix and performed a punch biopsy of the liver. The punch biopsy was done without consent from our client, who was at a high risk for bleeding.

Despite knowing that our client had an extremely low platelet count of 30,000 at the time of surgery, the general surgeon neither attempted to correct our client’s thrombocytopenia nor did he make and preparations for our client to have blood products post-operatively, should they be needed. The surgeon chose not to place a drain to help with the detection of any post-operative bleeding. The general surgeon did, however, dictate two different operative reports following this procedure. In the initial report, he notes that there was bleeding during the procedure in the lower quadrant. In the second report, this statement had been removed. 

Our client was places in the intensive care unit with an arriving blood pressure of 77/38, pulse of 132, and oxygen saturation of 94%. He was profoundly hypotensive and hypoxic without response to any of the therapy methods ordered. About three hours after being admitted to the ICU our client began having a seizure and stopped breathing. A code blue was called and the ICU doctor ordered that our client be typed, cross-matched, and transfused with packed red blood cells and fresh frozen plasma. It was also reported that our client had vomited blood during this time, and the general surgeon performed an EGD in an attempt to rule out a GI bleed. 

It was arranged for our client to be transferred to an even larger hospital under the care of a nephrologist. The general surgeon that performed the initial surgery on our client did not notify the nephrologist of our client’s intra-abdominal bleeding. The general surgeon also failed to communicate the urgent need for a surgery to repair the bleeding. Upon arrival to the larger hospital, our client had critical hematocrit and hemoglobin levels and was emergently evaluated by a surgeon. He was found to have abdominal compartment syndrome secondary to hemopertioneum, coagulopathy, hypotension, hypothermia, cirrhosis, renal failure, respiratory failure, and acute blood loss anemia. The surgeon was able to locate and repair the intra-abdominal bleed and removed 4000 ml of old blood and 2000 ml and blood clots. Despite the successful surgery, our client passed away two days later. 

When the medical review panel met on our client’s case they found that the diagnostic testing and initial surgical procedures were appropriate. They stated, however, that the initial general surgeon’s failure to recognize and treat the patient’s post-surgery bleeding were clear breaches in the standard of care. The panel also stated that the general surgeon’s breaches both preoperatively and postoperatively were factors in the damages suffered by our client. The medical review panel’s ruling played a major role in resolution of this case. Todd Townsley was able to make a just and satisfactory settlement for our client’s wife and children out of court.


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