Case details

Drainage and stricture known complications of surgery: doc





Result type

Not present

bile duct, digestive, gastrointestinal, hepatic, reconstructive surgery, scar tissue, stricture
On Feb. 13, 2011, plaintiff Hector Gerardo, 70, a retired automobile worker, underwent a laparoscopic cholecystectomy that had to be converted to an open procedure. Gerardo was initially admitted to St. Mary Medical Center in Apple Valley on Feb. 9, 2011, after he went into septic shock. Over the course of several days, he was stabilized and then diagnosed with acalculous cholecystitis, anacute inflammation of the gallbladder in the absence of gallstones. On Feb. 12, 2009, Dr. Vincent Ajanwachuku, a general surgeon, was asked to provide a surgical evaluation of Gerardo. He subsequently confirmed the diagnosis and took Gerardo to surgery the following day. During the laparoscopic cholecystectomy, adhesions were found to be obscuring the necessary landmarks for surgery, so the procedure had to be converted to an open procedure. During the open procedure, the gallbladder was dissected out from the fundus to the neck. The cystic duct and artery were then ligated and transected, and the gallbladder was removed. The gallbladder was determined to be gangrenous and necrotic, and to have ruptured, spilling abscess in the surgical field. As a result, several clips had to be used to control bleeding during the surgery and a Jackson-Pratt drain was placed at the conclusion of surgery to collect bodily fluids from the surgical site. Following the surgery, nurses noted drainage of 700-milliliters per day from the JP drain and Gerardo was discharged three days later. During a post-operative visit on March 1, 2011, Ajanwachuku recorded drainage of 100-milliliters per day and then, at a post-operative visit on March 10, 2011, drainage of 80-milliliters over the past 24 hours was recorded. On March 17, 2011, Gerardo returned for a third post-operative visit, during which Ajanwachuku recorded the drainage as being more than 700-milliliters per day. As a result, Ajanwachuku suspected a clip placed on the cystic duct stump had fallen off, a known complication. Following the third post-operative visit, Gerardo was referred for an HIDA scan and ultimately an endoscopic retrograde cholangiopancreatography. He was subsequently readmitted to St. Mary’s on April 9, 2011, and underwent an ERCP and placement of a stent to bypass a leak and obstruction in the biliary system. The leak resolved, but not the stricture, and Gerardo required biliary reconstruction surgery, which was ultimately performed at Loma Linda University Medical Center on Feb. 9, 2012. Gerardo sued Ajanwachuku. Gerardo alleged that Ajanwachuku’s actions constituted negligent treatment, surgical error and delayed diagnosis, and that these actions constituted medical malpractice. Plaintiff’s counsel contended that Ajanwachuku clipped Gerardo’s common hepatic duct during surgery, resulting in an injury to the common hepatic duct. Dr. Nephtali Gomez, who performed the biliary reconstruction surgery on Gerardo, testified that he found five clips on the wall of the common hepatic duct and one clip penetrating the common hepatic duct. In addition, plaintiff’s counsel contended that the 700-milliliters of drainage noted by nurses following surgery was consistent of a bile leak from the bile duct and disputed documentation presented by defense counsel that drainage was steadily decreasing the month following surgery before Ajanwachuku noted the 700-milliliters of drainage on March 17, 2011. Ajanwachuku denied clipping or otherwise the common hepatic duct during surgery. He claimed post-operative drainage was expected, secondary to a weeping liver bed that was very raw and secondary to the extensive dissection required to peel the gallbladder off the liver bed. Ajanwachuku also claimed the drainage that developed on March 17, 2011, was the result of a clip falling off the cystic duct stump, a recognized complication. He further claimed the stricture was not unexpected, given the extensive inflammation noted in the surgical field at the time of surgery, and that it was not related to an iatrogenic injury., Gerardo claimed the delayed diagnosis of the injury to the common hepatic duct led to a formation of scar tissue at the site of the injury and the stricture of the common hepatic duct. He claimed that as a result, he had to undergo several stent placements and, ultimately, major biliary reconstruction surgery. Gerardo alleged that he has recovered with minimal residual weakness and no other restrictions on his daily activities. Thus, he sought recovery of $200,000 in general damages only.
Superior Court of San Bernardino County, San Bernardino, CA

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