Diverticulitis Delayed Diagnosis Lawsuit

This medical malpractice claim was filed in Baltimore County after a delay in diverticulitis diagnosis caused a woman to suffer a colon perforation. It was filed in Health Claims Arbitration on January 30, 2018, and it is the 56^th medical malpractice case filed in Maryland this year.

A woman had been a patient at her internal medicine doctor's practice group for decades when she was first diagnosed with diverticulitis - an inflammation or infection in the small pouches of the digestive tract. She had two additional episodes of diverticulitis several years later, which her doctor treated successfully with Cipro. Shortly after her second flare-up, her doctor cleared her for foot surgery, noting that she "is an active 67-year-old female who will be at low risk for complications."

Several months later, the woman presented to her doctor with complaints of stomach problems, including constipation, harder stools, and bloating. She was leery of taking laxatives because her father had suffered perforated diverticulitis after taking laxatives. The doctor diagnosed her with generalized abdominal pain without describing the location, character, or extent of the abdominal pain in his notes. He did not take her temperature, but he did order blood work which showed an elevated white blood cell count and elevated neutrophils, classic signifiers of an active infection. At the end of the woman's visit, the doctor ruled out diverticulitis and told her it would be safe for her to take Miralax (a laxative) for the next few days.

The doctor ordered a CT scan of the woman's abdomen and pelvis one week later. Patients with diverticulitis commonly demonstrate typical features on abdominal CT scanning. Her CT revealed bowel wall thickening, periodic inflammatory changes, and multiple adjacent collections. Just as she feared, the woman was suffering from a severe episode of diverticulitis with a perforated colon.

The woman presented to the emergency room at the University of Maryland St. Joseph Medical Center (UMSJMC), where her diagnosis of diverticulitis complicated by abscess formation was confirmed. She was started on antibiotics, including metronidazole and levofloxacin, and she underwent an abscess drainage with catheter placement the next day. Her condition did not improve. Another CT showed that the abscess and inflammation had decreased in size, but there was new evidence of an abnormal connection between her sigmoid colon and bladder (a fistula). The woman underwent a bowel resection of her large intestine which revealed a large inflammatory mass in the left lower quadrant. Her doctors established a colostomy and removed the portion of her colon affected with diverticulitis.

Seven months later, the doctor at UMSJMC performed a reversal of the colostomy. During that surgery, the doctor encountered extensive adhesions throughout the woman's abdomen and pelvis. The adhesions were so dense in one area that the doctor had to remove the woman's right ovary and fallopian tube. He also repaired a parastomal hernia and checked to see if the fistula had healed, which it had. Although the woman made a healthy recovery, she endured several major surgeries and seven months with a colostomy bag as a result of the delayed diverticulitis diagnosis.

• Diverticulosis is defined as the condition of having uninflamed diverticula. The cause of diverticulosis is not yet conclusive, but it appears to be associated with a low-fiber diet, constipation, and obesity. Of patients with diverticulosis, 80-85% remain asymptomatic. Approximately 5% develop diverticulitis and about 15-25% of those with diverticulitis develop complications leading to surgery. These complications include abscess formation, intestinal rupture, peritonitis, and fistula formation.
• Diverticula are small pockets that can form in the digestive tract lining, found most often in the colon. Diverticulitis occurs when one or more of these pockets tear and become infected. About 25% of people who suffer from acute diverticulitis develop complications. Non-contained perforation with abscess formation is a life-threatening complication that only occurs in 1-2% of patients with acute diverticulitis.
• Persistent abdominal pain and constipation are two of the most common symptoms of diverticulitis. Particularly considering the claimant's medical history, her doctor should have immediately suspected another diverticulitis episode and ordered more extensive diagnostic imaging.
• The diagnosis of diverticulitis is usually made by CT scanning. But in the early stages of diverticulitis, a CT scan is often normal. There is also the possibility of false negatives. Some studies suggest rates of up to 20% have been reported. A 3-way abdominal x-ray is a good way to get indirect evidence of an acute abdominal process.
• The doctor's lawyer may argue that perforation of a diverticulum is a process that cannot be prevented with antibiotics, medication or other therapies. Roughly 20% of patient with acute diverticulitis will go on to perforation regardless of treatment. But that argument is likely to struggle to get traction in this case.

• Baltimore County

• Josephs, Turner & O'Malley, M.D., P.A.
• An internist

• University of Maryland St. Joseph Medical Center

• Failing to employ adequate diagnostic procedures to determine the nature and severity of the claimant's medical status.
• Failing to obtain an adequate history and physical examination.
• Failing to diagnose and treat the claimant's diverticulitis.

• As a direct result of the defendants' negligence, the claimant suffered a colon perforation, a colostomy, surgery to reverse the colostomy, extensive medical care and expenses, hernias, and scarring.
• Loss of Marital Consortium
• Informed Consent

• Richard M. Dwoskin, M.D., internal medicine and gastroenterology. He is board certified in the specialty field of internal medicine and the subspecialty of gastroenterology. He has testified before in diverticulitis cases.

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