Fistula Wrongful Death Medical Malpractice Lawsuit

Ridley v. Horizon Surgical Group, P.A.

Surgery Malpractice This lawsuit, filed on January 17, 2017, is a surgical negligence wrongful death claim filed on behalf of a woman in Montgomery County after she had an aortic aneurysm repaired. This claim is the 23rd medical malpractice case filed in Maryland in 2017.

Summary of Plaintiff's Allegations

The decedent has an abdominal aortic aneurysm resection with a bypass graft done at Shady Grove Adventist Hospital. She is discharged twelve days later for rehabilitation. One month after her discharge, defendant doctor evaluates her and finds that the circulation to her lower extremities has significantly improved. In his opinion, the woman's recovery is progressing as expected.

One week later, decedent receives two units of transfused blood as she has low hemoglobin and hematocrit, at Shady Grove. The following day, she begins to vomit and reports epigastric pain and nausea. She is very pale, and is transported to the ER at Shady Grove Adventist where she is admitted.

Testing reveals an ulcer in her stomach. This is stopped with a clip. Defendant doctor evaluates the woman and says her condition is unlike to be an aortoenteric fistula (an abnormal connection between the aorta and gastrointestinal tract) since she has an ulcer. For the following two days, she has rectal bleeding and bloody stools. She receives another blood transfusion.

She begins to have abdominal pain with urination, nausea, and vomiting. A CT of her abdomen shows a large high-density collection extending from her stomach and encompassing the abdominal aorta-perforation of her stomach.

Defendant doctor re-evaluates her, and believes the bleeding to be coming from her stomach. The same day, a nurse's note indicates that the woman is lethargic and weak. The decedent is soon transferred to the intensive care unit. After less than three hours, she becomes unresponsive, and blood is coming through her esophagus.

She has several procedures done by defendant doctor and other surgeons. Her infected aortic graft is removed and her aorta is repaired. She has a graft excision with new graft placement. After all these procedures, she has to return to the operating room to remove a sponge. Her condition declines, and she continues to bleed. She dies the following morning due to sepsis from the aortic graft infection. Her Estate brings this claim, alleging that the negligence of the surgeon led to the woman's death. Plaintiff believes the standard of care in these cases abdominal aortic repair and severe abdominal pain, back pain, increased white blood cell count, decreasing hematocrit, and guiac positive stool to order a surgical consult to determine the cause of the symptoms.

Additional Comments
  • An aortoenteric fistula is an uncommon by a well-known complication of an abdominal aortic aneurysm repair surgery.
  • The big deal with an aortoenteric fistula is early diagnosis and treatment. Delay can cause a ruptured aortoenteric fistula, causing an aortic bleed that could result in significant blood loss and death.
  • The gist of plaintiff's claim is twofold. First, the doctor breached the standard of care with a surgical error by putting a stitch through the duodenum or stitching the duodenum to the aortic bypass graft during the surgery. Second, he closed up the patient without seeing the error.
  • Plaintiffs argument is likely that the standard of care in these cases abdominal aortic repair and severe abdominal pain and these other symptoms consistent with an aortic abnormality would be to perform an exploratory surgery to determine the cause of the symptoms and rule out an aortoenteric fistula.
  • The procedure in this case, an axillobifemoral bypass, was the procedure at issue in Little v. Schneider, a malpractice case that reached the Maryland Court of Appeals on a discovery disclosure issue and a question of whether it was relevant that the defendant was not board certified.
Jurisdiction
  • Montgomery County
Defendants Hospitals Where Patient was Treated
  • Shady Grove Adventist Hospital
Negligence
  • Failure to perform abdominal aortic aneurysm repair correctly
  • Failure to recognize and repair technical errors during surgery
  • Failure to consider that decedent's bleeding was from a fistula
  • Failure to repair fistula timely
Specific Counts Pled
  • Wrongful Death
  • Survival Action
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