From the Guidelines
To prove a gastroenterologist was negligent when they perforated the cecum during a colonoscopy, you must establish that the perforation resulted from substandard care, rather than being a recognized complication, by gathering all relevant medical records and consulting with a medical malpractice attorney and a qualified medical expert. The incidence of iatrogenic colonic perforations (ICPs) during colonoscopy is estimated to be 0.016–0.8% for diagnostic colonoscopies and 0.02–8% for therapeutic colonoscopies 1. According to the 2017 WSES guidelines for the management of iatrogenic colonoscopy perforation, a multidisciplinary management involving gastroenterologists, endoscopists, surgeons, and anesthesiologists is recommended 1.
Key Elements to Establish Negligence
- Duty of care: The gastroenterologist had a duty to perform the colonoscopy with reasonable care and skill.
- Breach of duty: The gastroenterologist failed to meet the standard of care, resulting in the perforation.
- Causation: The perforation was caused by the gastroenterologist's breach of duty.
- Damages: The patient suffered damages, including additional medical treatments, surgeries, extended hospitalization, lost wages, and pain and suffering, as a result of the perforation.
Gathering Evidence
To establish these elements, you'll need to gather all medical records related to the procedure, including:
- Consent forms
- Procedure notes
- Post-procedure documentation
- Subsequent treatment records for the perforation You should also seek a qualified medical expert, typically another gastroenterologist, who can review your case and provide an opinion on whether the standard of care was breached 1.
Standard of Care
The standard of care for colonoscopy includes proper technique, adequate sedation management, and recognition of anatomical variations. Evidence of negligence might include:
- Improper technique
- Excessive force
- Failure to recognize anatomical variations
- Inadequate sedation management
- Proceeding despite contraindications The treatment strategy for ICPs should be chosen based on the clinical setting and the patient’s characteristics, and should be adapted to the medical team’s experience and local resources 1.
Timely Action
Most states have specific statutes of limitations for medical malpractice claims, typically 1-3 years, so timely action is crucial. It's essential to consult with a medical malpractice attorney who specializes in healthcare negligence cases to guide you through the legal process.
From the Research
Establishing Negligence in Cecal Perforation During Colonoscopy
To prove that the gastroenterologist was negligent when they perforated the cecum during a colonoscopy, several factors must be considered:
- The standard of care expected during a colonoscopy procedure
- The presence of any pre-existing conditions that could increase the risk of perforation
- The techniques and instruments used during the procedure
- The immediate response to the complication
Risk Factors and Standard of Care
Studies have shown that cecal perforation can occur due to various reasons, including mechanical obstruction of the distal colon 2, nonobstructive colonic dilatation 2, and as a complication of diagnostic biopsy 3. The standard of care requires that gastroenterologists be aware of these risks and take necessary precautions, especially in patients with pre-existing gastrointestinal disease 4.
Mechanisms of Injury
Endoscopic cecal perforation can occur due to direct injury from the endoscopic instrument, ancillary procedures such as biopsies or electrocautery, and cecal pathology like inflammation or ulceration 5. The fact that the patient had extensive pancolonic diverticulosis and a 4 mm sessile polyp in the descending colon may have increased the risk of perforation.
Response to Complication
The timely recognition and management of the perforation are critical in preventing further complications. In this case, the patient developed abdominal pain and distention, and an abdominal X-ray showed gaseous distention and pneumoperitoneum, indicating a perforation. The decision to transfer the patient to a Level 1 hospital and perform an ileocecectomy suggests that the complication was recognized and addressed promptly.
Determining Negligence
To determine if the gastroenterologist was negligent, it is essential to review the procedure in detail, considering the patient's medical history, the techniques used, and the response to the complication. The fact that the perforation occurred during the procedure suggests that it may have been related to the technique or instruments used. However, without more information about the specific circumstances of the case, it is difficult to say whether the gastroenterologist deviated from the standard of care.
Relevant Studies
Several studies have reported on the incidence and management of cecal perforation during colonoscopy, including a study that found a perforation rate of 0.33% in a series of 7535 colonoscopic examinations 4. Another study highlighted the importance of minimizing ancillary endoscopic interventions in the cecal region, especially in elderly patients with evidence of cecal inflammation 5. A case series reported on the occurrence of large intestinal perforations in patients with COVID-19 infection, although this is not directly relevant to the present case 6.