COMMENTARY

Malpractice in the Management of Small Bowel Obstruction

Albert B. Lowenfels, MD

Disclosures

January 09, 2017

Medical Malpractice in the Management of Small Bowel Obstruction: A 33-Year Review of Case Law

Choudhry AJ, Haddad NN, Rivera M, et al
Surgery. 2016;160:1017-1027

Summary

To gather information about malpractice lawsuits arising from patients with a diagnosis of small bowel obstruction, the authors examined three decades of information available for Westlaw, a compilation of legal data from federal and state jury decisions. A total of 156 cases were included, with more than half of malpractice cases arising from three states: New York, California, and Florida. The most frequent reason for litigation (107 cases) was failure to diagnose and institute appropriate treatment in a timely manner. In half of these cases, the decision favored the defendant (physician), 25% favored the plaintiff (patient), and 25% were settled out of court. The median payout was $1.1 million.

Viewpoint

General surgeons are well aware of how difficult it is to decide whether to operate on a patient with suspected intestinal obstruction. Furthermore, even making a correct diagnosis can be a challenge because the triad of typical findings (abdominal pain, vomiting, and distension) may not always be present. In 17% of patient cases, an internist was the defendant, suggesting that there was a delay in diagnosis by the referring physician. Presumably, many more malpractice suits arose over this prolonged period but were settled out of court. Hopefully, the frequency of intestinal obstruction will decrease, now that more and more operations are being performed laparoscopically, with less risk of forming adhesions.

Abstract

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