A ruptured or perforated esophagus needs fast medical attention
Standard treatment can include surgery or medications, but in a lawsuit that I filed the doctors did neither, and the patient died
I recently handled a wrongful death medical malpractice case on behalf of the family of a woman in her 40s who had terrible complications after a gastric sleeve procedure, which is a weight loss bariatric surgery.
Although she seemed to be doing well for the first few weeks, about a month after the surgery she experienced uncontrollable nausea and vomiting and could not eat or drink. She went back to the hospital emergency room for help.
In my experience as a Texas medical malpractice lawyer, the most common complications after bariatric surgery are a leak or gastric outlet obstruction. Both complications may require surgical correction. A leak is a serious situation because the escape of gastric contents into the abdomen can cause an infection. Gastric outlet obstruction occurs when the post-surgical stomach is so tight that liquid cannot pass through it.
In this person’s case, though, barium swallow studies and other imaging gave no indication of any leak or obstruction.
The next step in her evaluation was to perform an endoscopy. In an endoscopy, a doctor inserts a lighted camera through the throat and esophagus to be able to see parts of the gastrointestinal tract. Sometimes additional equipment is inserted during an endoscopy to operate or remove tissue for a biopsy.
During this woman’s endoscopy, the doctors discovered that she had mild gastritis, which is inflammation of the stomach lining. Gastritis ended up being the least of her problems, though.
After the endoscopy, her condition took a dramatic turn for the worst. Ultimately, they discovered that she had suffered an esophageal rupture.
What is an esophageal rupture or perforation?
The esophagus is a muscular organ that connects the throat to the stomach. If the esophagus develops a tear or hole (perforation) or ruptures, it is an emergency medical condition that requires hospitalization and urgent treatment.
The classic signs and symptoms of esophageal perforation include pain in the chest, shoulder, or abdomen; nausea; difficulty swallowing (dysphagia); difficulty breathing (dyspnea); and/or fever.
The number one risk factor for esophageal rupture is having a recent endoscopy. When patients come to the emergency room with symptoms consistent with an esophageal rupture or perforation, one of the first questions that the emergency physician will typically ask is whether they recently had an endoscopy (EGD). Other risk factors include a recent esophageal biopsy or dilation, reflux esophagitis, hiatal hernia, or esophageal strictures.
If you go to the emergency room or to see you doctor with these symptoms, and recently had an EGD, be sure to tell the doctor about that.
When a physician suspects an esophageal perforation, the standard of care requires obtaining vital signs and blood work. Doctors look for elevated white blood cells, because patients who have esophageal perforation or rupture often have sepsis, which is a blood-born infection that develops secondary to mediastinitis, an infection of the mediastinum (the area between the lungs).
Standard of care also requires ordering a chest x-ray or another radiology study called a gastrograffin esophagram, which can help identify a leakage or any irregularity in the esophagus.
All patients with an esophageal perforation should be admitted to the hospital and treated with broad-spectrum antibiotics and IV fluids.
While many people intuitively believe that an esophageal rupture or perforation must be corrected surgically, that is not always the case. Some studies have concluded that surgical treatment is only preferable if it can be done within 24 hours after the perforation. Factors that doctors typically consider on making the decision of whether to operate on the patient to fix the esophageal perforation include the patient’s hemodynamic status (blood flow), the location and size of the perforation, the type of the perforation, and degree of contamination (leakage).
In the case that I recently handled, the physicians unfortunately shows “none of the above” when it came to treatment. As a result, this relatively young patient developed severe sepsis and needlessly passed away.
We are here to help
If you or someone you care for has been injured from a surgical mistake or follow-up care, call Painter Law Firm, in Houston, Texas, at 281-580-8800, for a free consultation with an experienced medical malpractice attorney.
Attorney Robert Painter is a member of Painter Law Firm PLLC, in Houston, Texas, where he files medical malpractice and wrongful death lawsuits on behalf of patients and their families.
Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.
A physician has to supervise the care and prescriptions of nurse practitioners and physician assistants under written, signed agreements [...]read more
On 4/1/2018, the new law will end the current practice where doctors can secretly enter a DNR order against patient and family wishes [...]read more
A physician has to supervise the care and prescriptions of nurse practitioners and physician assistants under written, signed agreements
On 4/1/2018, the new law will end the current practice where doctors can secretly enter a DNR order against patient and family wishes
This article was originally published in the September/October 2017 edition of "The Houston Lawyer" magazine
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