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Sample Case Descriptions

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.