Page 40 - Avoiding Surgical Mishaps Part 1

SVMIC Avoiding Surgical Mishaps: Dissecting the Risks

CASE STUDY

A 34-year-old female patient was found to have a gastric mass
and was referred to a surgeon, who performed a hand-assisted

laparoscopic gastric wedge resection on January 11. She had
post-op abdominal pain, and a nasogastric tube was inserted.

She continued to have drainage from the NG tube while she
was in the hospital, and by January 14, an Upper GI series

identified a gastric outlet obstruction. The NG tube remained
in place to allow the obstruction to take care of itself until

January 16, at which time her clear liquid diet was advanced
to a soft diet. Reglan was added on January 17, because the

patient complained of nausea and abdominal pain. The surgeon
also ordered a CT scan and then handed off care to another

physician in the practice as he was going on vacation. At the
time that he handed the patient’s care over to the covering

physician, he had not yet received the results of the CT scan
and forgot to mention to that physician that he needed him to

review the results before allowing the patient to be discharged
home. Two days later, the covering physician determined that

the patient had made good progress with her diet and was able
to go home on pain medication and Reglan. He wrote the order

for the prescriptions and the discharge, without ever seeing the
CT that the surgeon ordered which showed a persistent gastric

outlet obstruction that required further treatment. The patient
was discharged home on January 19, post-op day eight.

Two days later, the patient was admitted to a different
hospital on January 21 with severe abdominal pain, nausea,

and vomiting. Bowel sounds were diminished, and labs were
abnormal. On January 22, 11 days after the gastric resection,

a CT scan showed significant gastric outlet obstruction and
the development of an abdominal abscess, so the patient was

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