INTERNAL MEDICINE, GASTROENTEROLOGY & GASTROINTESTINAL ENDOSCOPY

Dr. Solny serves as a medical-legal consultant and expert witness for both plaintiff and defense. He also performs IMEs both in person and via Zoom, nationally as well as internationally.

Sample Case Descriptions

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Development of Ulcerative Colitis Following an Accident

A middle-aged woman with no prior gastrointestinal issues was struck by an automobile while riding a bike, sustaining multiple bone fractures. She subsequently developed ulcerative colitis that ultimately progressed to involve most of her colon, necessitating chronic and likely life-long treatment. I was asked to consider whether the stress and anxiety caused by the trauma of the accident played a role in causing her ulcerative colitis.

Complications Following Perforation of the Colon During a Cesarean Section

A young woman suffered laceration of the colon during a Cesarean section. She subsequently developed sepsis, required multiple reparative surgeries and was ultimately left with a shortened small bowel and multiple, chronic gastrointestinal complaints. I was asked to evaluate her condition 4 years after the event and to offer opinions regarding her prognosis.

Difficulty Swallowing with Upper Gastrointestinal Endoscopy Showing No Evidence of Obstruction

A 38 year old man developed difficulty swallowing solid food. Upper gastrointestinal endoscopy revealed no evidence of intrinsic esophageal obstruction. The swallowing difficulties continued. Some 10 months later, he presented with evidence of a mass in the proximal esophagus. This mass was found to be due to a thyroid cancer that had compressed the esophagus extrinsically and ultimately, invaded it. At issue in this case was whether the gastroenterologist should have considered extrinsic compression of the esophagus when the upper endoscopy showed no intrinsic obstruction.

Perforation of the Colon Discovered Shortly After Spinal Surgery

A middle-aged woman underwent spinal fusion. Within days, she was found to have perforation of the colon and multiple intra-abdominal abscesses. The issues in this case concerned whether the colonic perforation was a complication of the spinal surgery as well as evaluation of her current gastrointestinal symptoms and her prognosis from the gastrointestinal perspective.

Failure to Timely Communicate and Act Upon an Important Laboratory Finding in a Patient with Ulcerative Colitis

A young man with active ulcerative colitis underwent sigmoidoscopy with rectal biopsies demonstrating active colitis. Ten days after the colonoscopy, the pathologist additionally found evidence of cytomegalovirus (CMV) on the rectal biopsies. These results were not communicated to the patient or acted upon at that time by the gastroenterologist. The patient's colitis worsened. He did not respond to aggressive medical therapy and he was hospitalized. The positive CMV results were communicated to the treating physicians at the hospital some 6 weeks after they were known to the original gastroenterologist. Appropriate anti-viral therapy was initiated but the patient required surgery to remove his colon. I was asked to consider whether it was a departure for the initial gastroenterologist not to have timely communicated and acted upon the CMV finding and whether this would or would not have obviated the need for colectomy.

Esophageal Narrowing Following Surgical Hiatus Hernia Repair and Aspiration during Subsequent Upper Endoscopy

An older woman underwent surgical repair of her hiatus hernia. Subsequently, she had difficulty swallowing and keeping foods down due to narrowing of the distal esophagus. Upper endoscopy showed retained food in the distal esophagus. Despite dilatation of this area, her symptoms persisted with ongoing regurgitation of food. She was admitted to the hospital with pneumonia and underwent a second upper endoscopy that also demonstrated the esophagus to be full of liquid contents and during which, she suffered massive aspiration of this fluid into her lungs. She required intubation and ultimately died. I was asked to consider the care rendered by the gastroenterologists and specifically, whether endotracheal intubation to prevent aspiration was indicated prior to her second endoscopy.

Gastrointestinal Drug Patent

I was retained as a defense Gastroenterology expert in a case where a generic drug manufacturer sought to invalidate the patent of a branded gastrointestinal drug and was sued by the brand manufacturer.

The defense theory included the lack of novelty and the obviousness of the patented drug as well as the equivalent therapeutic efficacies of the branded and the generic drugs.

Failure to Diagnose Colon Cancer

A 54 year-old woman whose mother had colon cancer was seen by her physician on multiple occasions for evaluation of constipation, abdominal pain, rectal bleeding and an iron-deficiency anemia. Ten months later she was found to have rectal cancer. I was asked to opine on whether this constituted a failure to diagnose colorectal cancer in a timely fashion.

Pancreatic pseudocyst, cardiopulmonary arrest

A middle-aged man developed a large pancreatic pseudocyst following a bout of acute pancreatitis and plans were for this to be followed. Shortly after hospital discharge, he was taken to the Emergency Room in cardiopulmonary arrest. The issue at hand was whether the pseudocyst played a role in the patient's death.

Post-endoscopy respiratory arrest

A 54 year old man with significant cardiovascular disease developed a respiratory arrest shortly after completion of an upper endoscopy. At issue was the necessity for the procedure and dosing of the sedating medications as well as the adequacy of the intra-procedure and post-procedure monitoring.

Post-colonoscopy abdominal pain

A 60 year old woman developed persistent abdominal pain upon arriving home from a colonoscopy. After calling the gastroenterologist's office, she was told to come to the office the next day if her pain continued. She was found to have a colon perforation and had surgical repair. The issues in this case are whether the diagnosis of perforation could have been made sooner and whether earlier diagnosis would have made a difference.

Rectal bleeding, normal colonoscopy, colon cancer found two years later

A 55 year old man underwent colonoscopy for intermittent episodes of bright blood per rectum. The study was normal save for internal hemorrhoids. He was found to have a colon cancer two years later. At issue were whether the cancer or its antecedent polyp was present at the time of the colonoscopy or whether the cancer developed post-colonoscopy.

Colonoscopy with incompletely prepped colon, colon cancer

A 53 year old man had serial colonoscopies because of a strong family history of colon cancer. The colon was described as poorly prepped during a number of colonoscopies. Twenty months after the last colonoscopy, also poorly prepped, a colon cancer was found. At issue was whether the incompletely prepped colon potentially obscured the tumor, whether the diagnosis could have been made sooner and whether an earlier diagnosis would have mattered.

Esophageal dilatation, stomach perforation

An elderly woman had progressive difficulty swallowing due to an acid-related esophageal stricture. Esophageal dilatation was performed and perforation of the stomach was noted after the procedure. I was asked to consider whether or not this was a risk inherent to esophageal dilatation.

Fall in recovery area post-colonoscopy

A 75 year old man, on renal dialysis, had an elective outpatient colonoscopy that was completed uneventfully. Post-procedure, while ambulating, he fell and fractured his hip. The issues in this case included the state of his hydration, the amounts and timing of his sedation and the adequacy of the post-procedure surveillance.

Treatment for H.pylori; aseptic meningitis

An elderly woman became confused during treatment for an H. pylori infection. The medications were stopped and subsequently restarted. She suffered aseptic meningitis with neurologic residua. I was asked to opine on the propriety of her medical treatment and whether her medications related to the neurologic complication.

Gentamicin treatment for acute diverticulitis

A 56 year old man developed renal toxicity and persistent loss of balance following treatment of acute diverticulitis with Gentamicin. At issue in this case were both the choice and the duration of antibiotic therapy.

Anticoagulation and gastrointestinal endoscopy

A 63 year old man with a history of colon polyps underwent follow-up colonoscopy three months after insertion of a stent to treat coronary artery disease. Aspirin and Plavix were discontinued prior to the colonoscopy. They were restarted three days post-colonoscopy, at which time he suffered an acute myocardial infarction. The issues in this case revolved around the interplay of anticoagulation and gastrointestinal endoscopy.

Alcohol withdrawal; respiratory failure

A 39 year old man who was admitted to the hospital with gastrointestinal bleeding, developed respiratory failure while being treated with benzodiazepines for alcohol withdrawal syndrome. I was asked to comment on the management and supervision of an agitated alcoholic patient.

Surgery for a biopsy-negative colonic mass

A 54 year old man was noted to have a mass in the cecum (far end of the colon) at colonoscopy. Biopsies of the mass revealed normal tissue and CT scanning was unremarkable. Surgery was performed and major post-operative complications developed. The mass turned out to be an inverted appendiceal stump from a prior appendectomy. I was asked to opine on whether surgery was an appropriate treatment option in this situation.

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