The proper medical procedure after identifying a malignant sigmoid tumor typically involves the removal of that tumor in a timely manner to optimize recovery and survival. Especially when the tumor is actively bleeding, causing anemia, the timeline on removal could be expedited.
As with all surgery, a colectomy – the surgical procedure performed to remove the segment of the sigmoid colon containing the tumor – assumes a level of risk that patients and physicians should take seriously.
One risk specific to a colectomy is bowel perforation, which can occur when a surgeon damages the bowel during surgery. A bowel perforation is a serious complication and can lead to life-threatening complications. Prompt recognition of a perforation is critical, as early diagnosis and timely repair are imperative for a patient’s survival.
In this case, fundamental errors were made in the post-operative care of our client, ultimately costing our client her life. The Townsley Law Firm represented her family and secured a settlement of over $425,000, holding the responsible parties accountable.
What Happened: Cancer Surgery Followed by a Cascade of Medical Failures
Admission, Diagnosis, and the Decision to Operate
Our client was admitted to the hospital after a colonoscopy identified a malignant sigmoid tumor that was actively bleeding, causing significant symptomatic anemia. The sigmoid colon is the lower portion of the large intestine, and a bleeding malignant tumor in that location is a serious condition requiring surgical intervention.
The treating physician evaluated her over several days. To address her anemia, the care team administered three units of packed red blood cells and one unit of fresh frozen plasma. These blood products were given to stabilize her blood counts before the planned procedure.
The physician performed an open sigmoid colectomy, a surgical procedure to remove the segment of the sigmoid colon containing the tumor. This is a major abdominal surgery with a defined set of intraoperative and post-operative risks that the surgeon and nurses are responsible for monitoring and managing.
That night, following the procedure, our client showed signs of post-operative anemia and was found to have critically low hemoglobin level. This was the first indicator that her recovery was not progressing as it should.
Mismanaged Post-Operative Bleeding
The post-operative bleeding complications experienced by our client were not appropriately recognized or managed by her medical team. Instead of being treated as a potentially serious and evolving post-operative complication requiring prompt and decisive intervention, her anemia and clinical decline were not addressed. Despite her continued deterioration, she was discharged from the hospital.
Following her discharge, she returned to the emergency department on three separate occasions with worsening symptoms after undergoing major abdominal surgery. Each trip to the ER was an opportunity to evaluate the source of her complaints and identify her post-operative complications and timely intervene. Despite these repeated visits, her underlying condition was not identified or treated.
When she was finally readmitted, diagnostic imaging was obtained. The imaging suggested she was suffering from a perforated bowel, a serious complication involving a hole in the wall of the intestine that allows bowel contents, including bacteria and fecal material, to leak into the abdominal cavity. This placed her at a significant risk for peritonitis, sepsis, abscess formation, and death. A bowel perforation requires urgent medical and surgical management.
The Three-Day Delay That Cost Her Life
A plain X-ray film identified free air in her abdomen. Free air, also called pneumoperitoneum, is the presence of air outside the gastrointestinal tract in the abdominal cavity. In a patient who has undergone recent abdominal surgery and is symptomatic, free air on imaging is a recognized surgical emergency. It means the bowel has been breached and the abdominal cavity is being contaminated.
The standard of care requires urgent surgical repair when a perforated bowel is identified in a symptomatic patient. Any delay allows further contamination of the abdominal cavity, increasing the risk of peritonitis, sepsis, organ failure, and death.
The surgical team waited nearly three days after identifying free air on the X-ray before repairing the perforation.
By that point, the damage to our client’s body was irreversible. She developed:
- Peritonitis: a severe and painful inflammation of the abdominal lining caused by bacterial contamination
- Septic shock: the most severe form of sepsis, in which the infection drives a collapse of blood pressure and organ perfusion
- Multi-organ failure: the progressive shutdown of vital organs as her body was overwhelmed by infection and shock
She died as a result of the medical teams’ failure to manage her postoperative complications and their three-day delay in repairing the bowel perforation that had been identified on imaging.
What Obligations Did the Surgical Team Have After Identifying Free Air?
When a surgeon identifies free air on imaging in a post-operative patient with deteriorating clinical findings, the surgeon is required to correlate the imaging finding with the patient’s clinical presentation, consider the finding in the context of the patient’s post-operative course and symptoms, make a timely determination about whether urgent operative intervention is indicated, and if the decision is made to observe rather than operate immediately, ensure that the patient is monitored with sufficient frequency and intensity that any further deterioration triggers immediate action.
The Townsley Law Firm established through expert medical testimony that the delay in surgical repair was a departure from the standard of care and that this departure directly caused our client’s peritonitis, septic shock, organ failure, and death.
Why Patients Are Discharged Too Soon After Colon Surgery and What Families Should Watch For
Post-surgical discharge decisions must account for the patient’s stability and the risk of complications. After a sigmoid colectomy, the standard recovery involves close monitoring for signs of anastomotic leak or bowel perforation, including fever, abdominal pain, distension, and abnormal vital signs.
When a patient is discharged before these risks have adequately passed, and particularly when the patient returns to the emergency room repeatedly with ongoing symptoms, the discharge decision and the subsequent ER evaluations both come under scrutiny in a malpractice claim.
Families who notice the following warning signs after a loved one has undergone colon surgery should seek immediate medical attention and, if concerns are dismissed, advocate loudly for further evaluation:
- Fever, particularly when accompanied by abdominal pain
- A rigid, distended, or firm abdomen
- Worsening rather than improving pain in the days following surgery
- Repeated trips to the ER with ongoing complaints that are not being adequately investigated
- Rapid heart rate or low blood pressure
- Nausea, vomiting, or inability to tolerate food
If these signs are present and the medical team is not responding with appropriate urgency, the patient or family has the right to demand a higher level of evaluation, including repeat imaging and surgical consultation.
What Is a Bowel Perforation After Colon Surgery and When Does It Become Malpractice?
A bowel perforation following colon surgery is a recognized potential complication of the procedure. Not every perforation constitutes malpractice. What can constitute malpractice is the failure to recognize a perforation in a timely manner, the failure to monitor a post-operative patient closely enough to detect the signs of a perforation, and most critically, the failure to surgically repair a known perforation within an appropriate timeframe.
In our client’s case, free air was visible on a plain X-ray film. That finding was documented. The surgical team was aware of it. They did not operate. During that window, our client developed peritonitis and progressed to septic shock and organ failure. Louisiana law requires that physicians and surgeons exercise the standard of care of a reasonably competent professional in the same specialty under similar circumstances. A delay in repairing an identified bowel perforation in a symptomatic, post-operative patient is a departure from that standard.
What Is Free Air on an X-Ray and Why Is It a Surgical Emergency?
Free air, or pneumoperitoneum, is the radiological finding of air or gas present in the abdominal cavity outside of the gastrointestinal tract. In a patient who has not recently undergone surgery, this finding almost always indicates a perforated viscus, meaning a hole somewhere in the gastrointestinal tract that is allowing air and contents to escape.
In a postoperative patient, some residual free air from the surgery itself can be expected in the days immediately following the procedure. However, the clinical picture must be taken as a whole. A post-operative patient with free air on imaging who also has worsening symptoms, signs of infection, a deteriorating clinical status, and a history of three emergency room visits is not a patient with expected residual surgical air. She is a patient with a bowel perforation that requires urgent repair.
Emergency medicine and surgical guidelines are clear on this point. When clinical findings and imaging together suggest an anastomotic leak or bowel perforation in a post-operative patient, the threshold for operative intervention must be low. Waiting three days to act is not a clinical judgment call. It is a failure to intervene in a recognized surgical emergency.
What Is Peritonitis and How Does It Lead to Septic Shock?
Peritonitis is the inflammation of the peritoneum, the thin tissue layer that lines the abdominal wall and covers most of the abdominal organs. It most commonly results from a bacterial infection that enters the abdominal cavity through a ruptured organ, a perforated bowel, or a leak from a surgical site.
When fecal matter and bacteria enter the abdominal cavity through a bowel perforation, the body mounts an intense inflammatory response. Initially localized, the infection spreads rapidly across the peritoneum. The patient experiences severe abdominal pain, fever, nausea, and a rigid or board-like abdomen. Without surgical intervention to repair the source of contamination and wash out the abdominal cavity, the infection continues to spread.
Peritonitis that is not promptly treated progresses to sepsis, in which bacteria and their toxic byproducts enter the bloodstream and trigger a systemic inflammatory cascade. Sepsis then progresses to septic shock, characterized by a dangerous drop in blood pressure, inadequate delivery of oxygen to vital organs, and the rapid onset of multi-organ failure. Once a patient reaches septic shock with organ failure, the mortality rate is high even with aggressive intensive care.
In our client’s case, this progression was not inevitable. It was the result of a three-day delay in repairing a bowel perforation that had already been identified.
