Colonoscopies are widely used for diagnosis and are clearly the gold standard for colon cancer detection and recommended for all adults ages 50 and older. Colonoscopies have saved an untold number of Maryland lives, fighting the insidious disease of colon cancer by allowing for crucial early detection. Colon cancer is reported to be the second most diagnosed cancer, and the second leading cause of cancer death in the U.S. Most colonoscopy injuries are not the result of medical malpractice, but, some are. If you think your injuries during a colonoscopy may have been caused by a medical mistake, call 800-553-8082, or get a free on-line consultation.Colonoscopy Injuries
Colonoscopies are usually well tolerated by the patient; however, injury can occur when the doctor performing the procedure is not skilled and does not perform the test with the appropriate level of care. Potential injuries which may arise include hemorrhaging following polyp removal, aggravation of underlying bowel disorders (e.g. Crohn's disease, irritable bowel syndrome, etc.), and more serious injuries such as bowel perforation, sepsis, and splenic tear/rupture. Certainly, not all of these injuries are from medical malpractice. In fact, as discussed below, the vast majority of bowel perforations are not the result of medical malpractice. Many colonoscopy related problems are, however, the result of a mistake by the doctor performing the procedure.
Reported rates of serious injury due to colonoscopies vary in the literature between 0.34% and 2.5%. Risk of bowel perforation is estimated to be 0.2-1.0%. Perforation of the bowel can lead to sepsis, which can be fatal. Sepsis occurs when bacteria enter the bloodstream and the immune system goes into overdrive. This can result in organ dysfunction. Splenic injury due to a colonoscopy is rare (approximately 1 in 6,387 colonoscopies or 0.015%), and may go undiagnosed due to non-specific symptoms; however, a delay in diagnosis can be serious and even fatal.
There are three potential mechanisms for splenic injury:
- Formation of abdominal adhesions associated with a history of abdominal surgery
- Increased splenocolic ligament traction associated with snare polypectomy and/or forceps biopsies performed during the colonoscopy
- Direct trauma to the spleen (may occur due to external or internal pressure from the colonoscope)
External abdominal pressure may be applied to help ease technical difficulty encountered by preventing looping and reducing the angles in the colon. However, application of too much pressure can result in direct trauma to the spleen.
Risk factors for splenic injury include anti-coagulant (blood thinner) therapy, irritable bowel disorder, gender (females are at higher risk (3:1) compared to males), history of multiple prior colonoscopies, and enlargement of the spleen (splenomegaly).Perforated Bowel During Colonoscopy: Is this Malpractice?
One common complication during colonoscopies is perforating the colon which, in laymen's terms, is making a cut or hole in the colon by mistake. Perforation of the bowel and splenic injury can both present with abdominal pain. Abdominal pain occurs on the left side and is often associated with radiating pain to the left shoulder. The pain is usually progressive and persistent. Dizziness may also occur in some patients. Most patients with splenic injury report problems within 24 to 48 hours of the colonoscopy. Laboratory tests may also reveal a drop in hemoglobin and hematocrit. Perforation should be ruled out prior to diagnosis of splenic injury, as bowel perforation is a more common complication of colonoscopy.
Bowel perforation is a recognized risk of a colonoscopy. Many doctors think this is the end of the malpractice question when in fact, it is only the beginning. Many "recognized risks" are also medical malpractice. But, in this case, it can and does happen frequently in the absence of medical malpractice.
Where the malpractice comes in, in perforated colon cases, is where the doctor refuses to admit that the colon was perforated, and the patient fails to receive the treatment that is needed to best resolve the problem. It is important for problems encountered during a colonoscopy to be documented so that the appropriate follow up can be provided, and these notes may also aid in proper diagnosis should complications arise. Colonoscopies are usually outpatient surgeries, thus determinations of colonoscopy injury prior to release may not be feasible. Proper follow-up in high risk patients, including those in which technical difficulties arose during the colonoscopy, are important factors in ensuring potentially fatal complications are averted.
It is worthwhile to keep in mind that a diagnostic colonoscopy has a different risk than a therapeutic colonoscopy where you take out a polyp, cauterize an angiodysplasia, or perform some other therapy. The risk is much higher for a therapeutic colonoscopy. The diagnostic colonoscopy rate of perforation is less than one-tenth of one percent, on the order of a tenth of a percent. Diagnostic perforations are more likely to be malpractice.
What Types of Colonoscopy Related Malpractice Claims Are Successful?
Most of what we have written about colonoscopies is what is not considered medical malpractice. There are, however, many colonoscopy injuries that are malpractice. These are but a few examples of successful fact patterns in colonoscopy medical malpractice cases:
- Negligent in completing the colonoscopy, in light of the fact that the bowel preparation had been given only hours earlier
- Lack of informed consent
- Failure to timely diagnose or treat irritable bowel syndrome while performing colonoscopy
- Failure to recommend a sigmoidoscopy or colonoscopy to identify a source for the rectal bleeding or other symptoms consistent with colon cancer
- Colonoscopy complications in patients where the doctor did not explain to the patient that they had a higher than normal risk of complications
- Negligent attempting to pass the colonoscopy instrument through a colon structure which was overly dilated
If you live in the Baltimore Washington area and believe you have been a victim of medical negligence in Maryland, call 800-553-8082 or get a free online medical malpractice consultation.Colonoscopy Verdicts and Settlements
These are hard cases to settle without filing suit. Below we have complied a list of verdicts and settlement in colonoscopy error cases. Can you use this to help figure out the potential value of your claim? Yes, you can up to a point. But there are so many factors involved in valuing these claims that it is possible to read the exact same fact pattern and how a very different case value. These cases just have too many variables of differing weight to make hard conclusions.