Case details

Doctor: Perforation caused by stress ulcer, not surgery





Result type

Not present

back, bowel, cardiac, colon, dialysis, digestive, duodenum, gallbladder, gastrointestinal, heart, incisional abdomen, intestine, kidney failure, laparotomy, nia, perforation, pulmonary, renal failure, respiratory, respiratory arrest, septic shock, tachycardia, ulcer, urological
On Feb. 11, 2010, plaintiff Renee Gomez, a grocery store clerk in his 40s, underwent a laparoscopic cholecystectomy by Dr. Nabil Koudsi at Montclair Hospital. Gomez initially presented to Arrowhead Regional Medical Center in Colton with symptoms of gallbladder disease on Feb. 9, 2010. She was subsequently diagnosed with gallstones and followed up with her primary care physician, who directed her to Montclair Hospital. As a result, Gomez was admitted under the care of the surgical consultant, Koudsi, and she underwent a laparoscopic cholecystectomy. The pathology ultimately showed an acute necrotizing gallbladder. While Gomez was recovering from surgery, she developed tachycardia and low blood pressure. After additional consultants were brought in, Gomez was transferred to the Intensive Care Unit before Koudsi ordered Gomez’s transfer to San Antonio Community Hospital in Upland for a higher level of care. Upon admission to the new hospital, Gomez was diagnosed with possible septic shock and admitted to the ICU at that hospital. On Feb. 15, 2010, Gomez underwent a CT scan of her abdomen, and the impression was of subcutaneous fluid in the right flank and blood around the liver. A follow-up CT scan was then performed on Feb. 18, 2010, and it was revealed that Gomez had a perforation of the descending duodenum. As a result, she underwent an open laparotomy, during which a tiny hole was located in the duodenum. As a result, the post-operative diagnosis was a perforated duodenal ulcer. Gomez sued Koudsi; the operator of Montclair Hospital, Prime Healthcare Services III, LLC; and San Antonio Community Hospital. Gomez alleged that Koudsi was negligent both intra- and post-operatively, and that this negligence constituted medical malpractice. The two hospital entities each filed motions for summary judgment, which were unopposed, and they were dismissed from the case. Thus, the matter proceeded to trial against Koudsi only. Gomez alleged that Koudsi perforated her descending duodenum during the laparoscopic cholecystectomy on Feb. 11, 2010. She claimed that Koudsi should have converted to an open procedure, which would have provided better visualization and avoided the intraoperative injury. Gomez further claimed the injury should have been diagnosed earlier, due to her exhibiting signs and symptoms of sepsis, and that Koudsi should have taken her back to the surgery by Feb. 15, 2010. Koudsi claimed that all of the care he provided to the patient was within the standard of care and that there was no indication that he should have converted the laparoscopic cholecystectomy into an open procedure. He also claimed that he did not perforate the duodenum during the procedure and that Gomez’s post-operative care was appropriately managed. Koudsi further claimed that Gomez developed a stress ulcer sometime between Feb. 15, 2010, and Feb. 18, 2010, which caused the perforation, and that there was no indication for additional surgery until the CT scan revealed the perforation on Feb. 18, 2010., Gomez sustained a perforation of the descending duodenum. She claimed that as a result, she developed tachycardia and low blood pressure after the laparoscopic cholecystectomy and was ultimately transferred to another hospital, where she was diagnosed with possible septic shock. After CT scans revealed the perforation, she underwent an open laparotomy and subsequently remained hospitalized until March 3, 2010, before being discharged to home health care. Gomez claimed that Koudsi’s negligence led her to have a longer hospitalization, during which she dealt with acute renal (kidney) failure, requiring dialysis, and respiratory failure. She also claimed that after she was released, she suffered ongoing abdominal and back pain, as well as fatigue, which caused her to have difficulty standing, bending and lifting. In addition, she claimed she developed an incisional hernia one year later. Gomez claimed that she still suffers from residual pain and that her condition caused her to miss several months of work. Thus, she sought recovery of $500,000 in damages for her pain and suffering, as well as recovery of medical costs and lost earnings. Defense counsel argued that the duodenum was not perforated during the laparoscopic cholecystectomy, but was caused by a stress ulcer sometime later. Counsel argued that as a result, any ongoing symptoms, as well as Gomez’s alleged incisional hernia, were related to the severity of her gallbladder disease and not due to Koudsi’s treatment of Gomez.
Superior Court of San Bernardino County, Rancho Cucamonga, CA

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