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$1,300,000 Recovery in Failure to Diagnose Large Bowel Obstruction Case

Daryl L. Zaslow of Eichen Crutchlow Zaslow, LLP (Edison, Red Bank and Toms River), obtained a $1,300,000,000 settlement on behalf of a 67-year-old woman who required a total colectomy with ileostomy as a result of an alleged failure to timely diagnose and treat a large bowel obstruction. The settlement was reached on December 21, 2018 during a settlement conference before the Honorable Craig L. Wellerson, J.S.C.

Mr. Zaslow’s client was 61 years old when she presented to the Emergency Department of Ocean Medical Center on August 23, 2013 complaining of constipation. She had a recent diagnosis of breast cancer and had underwent her first round of chemotherapy (Cytoxan/Taxotere) four days previously. The emergency physician noted that her bowel sounds were normal, and he ordered KUB study or plain abdominal x-rays which revealed a moderate amount of stool, no air fluid levels, and no evidence of mechanical obstruction. She was discharged home with a diagnosis of constipation and instructions to continue self-administer another Fleet Enema the following day if constipation continued.

The Plaintiff returned to the Ocean Medical Center Emergency Department via ambulance the next day, August 24, 2013, where she was seen by the Defendant an emergency medicine physician. At this time she was complaining of vomiting, abdominal pain and ongoing constipation. The pain was described as diffuse, constant, and moderate-severe. On physical examination, the abdomen was described as without distension. Bowel sounds were active and there was moderate tenderness to palpation was noted in all quadrants. The Defendant did not perform a rectal examination and his differential diagnosis included: “Bowel obstruction, irritable bowel syndrome, pancreatitis, and fecal impaction.” The emergency physician reviewed the KUB images from the day before, noting that there was no evidence of a mechanical bowel obstruction and he discharged the patient with instructions to follow up with her oncologist.

Mr. Zaslow and the Plaintiffs’ experts argued that the Defendant deviated from the accepted standard of care at the August 24, 2013 visit, which was her second in 24 hours, and which should have been a red flag to the Defendant. In this setting in which his differential diagnosis included bowel obstruction and fecal impaction Plaintiffs’ experts maintained that the Defendant was required under the standard of care to order a CT scan of the abdomen in order to exclude dangerous intra-abdominal pathology, including a bowel obstruction. Had this been performed on August 24, 2013, Plaintiffs maintained it would have revealed evidence of the colonic obstruction.

The patient returned by ambulance to the Emergency Department on August 26, 2013 complaining of vomiting, abdominal pain, constipation and weakness. On examination, she was described as “obviously ill” with mild abdominal distension and mild lower abdominal tenderness. A CT of the abdomen was ordered at this visit which was consistent with a large bowel obstruction. A surgical consultation was performed and confirmed the diagnosis of large bowel obstruction based on the CT scan and the Plaintiff underwent an emergency exploratory laparotomy. Findings at surgery included a complete large bowel obstruction due to a rectosigmoid stricture. The colon was described as “massively distended and dilated with venous engorgement as well as multiple serosal splits.” This required a total colectomy with ileostomy and Hartmann pouch of the rectum.

Mr. Zaslow and Plaintiffs’ experts maintained that had the Defendant ordered a CT of the abdomen when the Plaintiff returned to the emergency department on August 24, 2013, the results would have demonstrated a large bowel obstruction. This would have triggered a surgical consult before the colon was compromised. This would have led to a decompression of the colon before it was fully comprised, obviating the need for a total colectomy and permanent ileostomy. Had a CT scan been done at that time standard intervention could have been undertaken avoiding the extensive surgery she had and eliminating the need for a permanent colostomy and the prolonged post-operative course she sustained.

After several months of recuperation, Mr. Zaslow’s client returned to work. Although she is a candidate for reversal of the ileostomy, even if there was an attempt to close her ileostomy at this time, there would be risks of multiple complications including bleeding, infection, bowel or ureteral injuries, hernia formation, post-operative intestinal obstruction, and more. As such, at this time, she has no intention of undergoing a reversal of the ileostomy.