Sunday, February 21, 2021

Malpractice Case Involving Accidental Incision of the Common Bile Duct

       We’re almost through the month of February! Can you believe that? How are you doing? We’re pretty much a month into this semester… wow! I want you to know that you got this! Keep putting in the work, the time and effort, and know you will make it to the end with that J.D. degree in hand. This week, I want to share a case with you involving a surgeon who accidentally cut into a patient’s common bile duct. Happy Reading! 

The Plaintiff suffered from inflammation of the gallbladder (known as cholecystitis) and came under the Defendant surgeon’s care to get his gallbladder removed (known as cholecystectomy). The Defendant surgeon originally decided to use an intraoperative cholangiogram (an x-ray tool that gives surgeons a real-time video of the patient’s bile ducts), but just prior to the start of the procedure, decided not to, “because the patient’s white blood count was within normal limits”. The surgery was performed on August 21, 2013.

About eight days after the surgery, the Plaintiff reported back to the Defendant surgeon after experiencing abdominal pain. Blood work was done which revealed elevated white blood cell count. The Defendant surgeon referred the Plaintiff to get an endoscopic retrograde cholangiopancreatography (ERCP) which is a procedure done to diagnose problems in the gallbladder. 

The results of the ERCP test showed “findings concerning for common biliary duct transection” which means there was a cut found in the common biliary duct. Thereafter, on September 2, 2013, “the Plaintiff was taken to the operating room for surgical exploration and a Roux-en-Y hepaticojejunostomy with intraoperative cholangiogram was performed.” This is a procedure that allows digestive juices to drain from the liver directly into the small intestine. 

In preparation for trial, the Plaintiff obtained an expert medical opinion from a general surgeon who is board certified and who had performed hundreds of similar surgical procedures that the Defendant surgeon performed. “He opined that the Defendant [surgeon] failed to meet the standard of care by failing to identify and verify the anatomical landmarks necessary during a laparoscopic cholecystectomy, namely the cystic and common bile ducts”. The expert was planned to testify at trial “that if there is any uncertainty, a surgeon should perform an intraoperative cholangiogram to clearly identify the biliary structures before cutting”. 

Due to the surgery complications, the Plaintiff is at a higher risk for biliary strictures, liver injury, liver failure, and the need for further hospitalizations for treatment of cholangitis. The Defendant argued that “such an injury is a known and foreseeable risk of laparoscopic cholecystectomy, even in the absence of negligence”. He claimed that, “there are multiple variations on ductal anatomy that can contribute to injury and that injury occurs in 1.5 percent of all gallbladder operations”. 

Trial was pushed off because of COVID-19 but the parties started discussing settlement offers. The case eventually settled for $250,000. 

Massachusetts Lawyers Weekly Vo. 49, No. 48


Do You Side with the Plaintiff Patient or the Defendant Surgeon? Why?


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