Let's get this out of the way right now...
A colostomy bag is not pleasant.
A colostomy bag collects your bowel movements, also known as feces.
A better way to describe it is poop. Shit. Yes, literally it collects your shit.
Rather than pooping the normal way, out your butt, your poop is diverted surgically to come out of a hole in your abdomen. A bag is then connected to that whole to collect all of your waste products that ordinarily you would expel while sitting on the toilet.
There many different reasons someone would need a colostomy bag.
For the purposes of this conversation, I want you to assume that you, the patient, are scheduled to have a routine colonoscopy.
A gastroenterologist or a bowel surgeon will perform this procedure either in the office or in an ambulatory surgery facility.
You are given light sedation intravenously.
A fiber-optic tube is then inserted into your rectum (your butt) in an effort to visually inspect the entire length of your bowel and colon.
There are significant benefits to this.
It allows the physician to observe if there are any polyps or cancerous growths throughout your colon.
If there are polyps, the doctor can remove them and send them to pathology for evaluation.
While you are sedated, the doctor explores the entire length of your bowel.
The anesthetic medication that is used creates a very comfortable and relaxed feeling when you awaken.
Patients often have no memory of anything that occurred immediately after receiving the IV sedation. It works almost instantly.
There are instances where patients will have blockages or scar tissue within the colon.
In that instance, it might be challenging for the doctor to pass the colonoscope (the fiber-optic tube with a tiny camera) through the obstruction. Using excessive force runs the risk of injuring the bowel or even perforating it.
There are other instances where the doctor will attempt to navigate the colonoscope through the twisted portions of the bowel and have difficulty doing so. In that instance, it is possible that injury to the bowel can occur as well as a bowel perforation.
Any doctor who performs a colonoscopy has an obligation to inform you prior to the procedure that there certain inherent risks associated with this type of procedure.
Even though this is a commonly performed a procedure in the United States, it still has risks.
Those risks may be magnified when the doctor performing the procedure does very few of them each year.
Those risks may be magnified when a physician encounters a complication he has never encountered before.
There are risks of anesthesia.
Their risks of injuring the bowel as well as adjacent organs.
This particular screening test often has far greater benefits compared to the potential risks that could occur.
Doctors will often encourage patients of a certain age to undergo colonoscopy in an effort to identify precancerous or cancerous lesions.
We are all aware of the importance of identifying cancers at an early stage.
We are also familiar with the adage that the earlier a cancer is detected, the earlier treatment can be given and the patient will likely have a better outcome the earlier cancer is detected.
Let's get back to the title of this article.
You wake up after undergoing a colonoscopy and you realize that you have colostomy bag sitting outside your belly and it has a foul odor.
Here's what you didn't know...
During the course of your routine colonoscopy, your gastroenterologist encountered a problem.
While he was trying to manipulate the colonoscope in your bowel, it appears the surgical instrument perforated your bowel.
The good thing is that you already had a bowel prep.
In case you don't know what a bowel prep is, it's an attempt to clean out everything in your bowel before the colonoscopy procedure.
By cleaning out your entire bowel, it allows the doctor to visualize the entire length of your bowel without any obstruction.
If you have not cleaned out your bowels before the procedure, it would be difficult, if not impossible, for the surgeon to pass the fiber-optic scope through your poop that still has not been expelled out of your body.
If you have never had a colonoscopy before and done a bowel prep, you should know that it is not pleasant.
The medications you are given to take orally for your bowel cleansing often tastes disgusting. It also requires you to drink massive quantities of liquid.
These medications literally induce your body to begin having frequent bowel movements over a period of hours.
During this “prep session,” your doctor will advise you to stay home and be close to the bathroom since you will need to run frequently to the bathroom in order to violently expel whatever is still left in your bowel.
This bowel prep is the most unpleasant part of the procedure.
During the actual procedure itself, you don't feel anything since you are under anesthesia and wake up refreshed.
Except of course when you wake up with colostomy bag attached to the outside of your belly.
In that scenario, the doctor who performed the procedure recognized immediately that he caused an injury to your bowel.
Unlike with cutting your skin on the outside of your finger, a doctor cannot leave it alone hoping it will close up by itself. Instead, you're likely going to be heading to the operating room for surgery.
If this is done in an ambulatory surgery facility, it's likely you will be transferred to the main operating room where a general surgeon or a bowel surgeon will be called in to repair your bowel perforation.
If your colonoscopy is being done in a doctor's office, an ambulance will need to be called and then you will need to be transported to the closest emergency room.
There are instances where the surgeon who is performing the bowel repair is simply able to sew together the perforation without any further treatment. That's called oversewing the bowel.
Let's see if this analogy helps visualize the situation...
Let's say your favorite pair of socks has a hole by the big toe.
You can grab a needle and thread and sew the hole closed and wear your socks as if they were good as new.
However, if the hole in your sock is an irregular shape and has destroyed the seam, it may be impossible to simply sew it closed.
You might need additional fabric to close the hole.
You might need to reshape the hole in order to make it smooth and even the edges of the fabric so they can easily come together when closed with a needle and thread.
The same scenario occurs during your bowel surgery.
Your surgeon must make a judgment call about whether he can oversew the bowel, or whether he can close the perforated segments together.
Learn what 'running the bowel' means in this quick video below. Then keep reading...
If he is able to do that, then you may not need a colostomy bag.
If the surgeon determines that your perforation is too large, he may have no choice but to actually remove that perforation and the tissue surrounding it.
Doctors often refer to that as removing an open defect.
What that really means is that the surgeon will cut out the offending portion of bowel on both sides.
From a mechanical standpoint it means he is now literally cutting the bowel. Twice.
Imagine a pipe.
It has a hole in it.
If the hole can't be filled to make it watertight, it must now be cut from the pipe.
You cut to the right of the hole.
You then cut to the left of the hole.
The challenge is that once the perforated area of bowel has been removed, the two ends of healthy bowel need to be reattached together.
The doctors call this procedure an end-to-end anastomosis.
It is critically important that when the two ends are brought together and sewn closed, that a watertight seal is made in order to prevent any leakage of bowel contents outside of the bowel.
If there is some type of bowel leak where the two healthy portions of bowel are connected together, that could be devastating for the patient.
If there was a leak at the anastomosis site, that would mean that your poop would be leaking into your abdomen.
If that were to happen, that would likely cause you to develop a significant infection.
If not recognized promptly, that infection can spread throughout your entire body.
The doctors call that type of infection sepsis. It's also known as a septic infection.
You should know that if sepsis is not timely diagnosed and treated, it can cause death.
Watch this quick video to learn what sepsis is, then continue reading below...
I've handled many cases involving medical and surgical procedures where the patient experienced a perforated bowel.
In the cases that I've handled they always involve a doctor who failed to timely recognize that there was a bowel perforation.
More on that shortly.
Let's get back to what happens after the doctor has performed an end-to-end anastomosis.
In some cases, the surgeon will not need to create a diversion in order to allow the anastomosis time to heal.
In other cases, the surgeon will need to divert your poop, for about 3 months in order to allow the anastomosis site to heal.
By now, you realize that you cannot survive if your waste products are not expelled somehow.
If your surgeon can't allow your normal bowel movements to pass through your colon, then there has to be some other way to get your poop out of your body without passing through the healing tissue.
Lucky for you, there is a way.
That way involves creating a diversion early in the digestive process.
When I talk about a diversion, what that really means is that the surgeon will make a hole in your bowel (known as an ileostomy) and then attach that portion of the bowel directly to a hole in your abdomen.
That means that your bowel contents will now be diverted out to a hole in your abdomen and into a bag that you must replace frequently.
This process will go on over the next three months so that your original bowel injury and repair can heal.
After three months, assuming you have not suffered any type of postoperative infection, your surgeon will then perform another surgery to reverse the colostomy bag.
That means that when you go back in for surgery, your surgeon will close up the hole in your abdomen and then reconnect the two ends of the bowel together so you have a normal flow of poop throughout your colon.
Many patients in this predicament are naturally upset.
Many are frustrated.
Many patients' lives are altered significantly for the next three to five months while they deal with a bag outside your body to collect your poop.
It is not fun.
It is not pleasant.
But the alternative is nothing great either.
But let's get back to the original concept I raised earlier...
You walked in for colonoscopy and you woke up with a colostomy bag and learned that you just underwent major abdominal surgery to repair your bowel injury.
While you are home recuperating, you get angrier by the day.
You realize this never should have happened.
Had you known that this was a risk of the procedure, you likely would not have proceeded forward with this elective procedure.
You begin to question whether your doctor did the right thing.
You begin to questio your doctor's qualifications.
You wonder whether any patients like you have had the same exact complication.
The answer is, yes.
This is not an isolated instance.
Thankfully, it does not happen that often.
But getting back to the more important question of whether you may have a valid basis for a medical malpractice case, let me share with you what I look for when evaluating such a case.
You should know that in New York, where I practice exclusively, I am not permitted to bring a medical malpractice lawsuit unless I have had a medical expert review all of your records who confirms that
- There was wrongdoing,
- The wrongdoing caused injury and
- The injury is significant and/or permanent.
Only if my medical expert can confirm each one of those things am I permitted to go ahead and file a lawsuit on your behalf.
From your standpoint, you believe you have a valid case.
You believe you walked into your colonoscopy relatively healthy and walked out with lots of complications.
You will now require months of recuperation and an additional surgery.
I get it.
I understand that.
I understand your frustration too.
But join me for a moment as I share with you the key questions I need to answer in order to let you know whether you may have a valid basis for a case.
One of the first questions I will ask is whether the doctor recognized your bowel injury during your colonoscopy.
If the doctor recognized your injury during your procedure, he will stop the procedure and now make arrangements to get you into surgery to repair the problem.
If you were to try and bring a lawsuit in that instance, your doctor would rightfully argue that your bowel injury was a known risk of the procedure, and that he did nothing wrong.
He will argue this was an unfortunate complication that could not have been avoided.
In that instance, I would need to evaluate whether the colonoscopy was warranted to begin with.
Let's look at the more egregious situation where your doctor fails to recognize there is any injury during the course of your colonoscopy.
In that instance, your doctor completes the procedure and you are woken up from anesthesia. After spending 30 minutes in the recovery room, you are given discharge instructions and told you can go home.
Later that night you begin to experience significant abdominal discomfort and and decide to call the doctor on call.
You tell the doctor you are having significant abdominal discomfort after your colonoscopy which you had earlier that day.
The doctor has only two choices to make during this phone conversation.
He will listen to your complaints and then ask you a series of questions to determine whether this problem is normal postoperative discomfort or whether it rises to something more significant that requires immediate evaluation.
The doctor's two choices really are to (1) reassure you that this is normal or (2) send you to the emergency room to be evaluated with a hands-on evaluation by an emergency room physician and/or a general surgeon.
I've encountered many cases with this exact scenario.
The ones I've handled typically involve a patient who was sent home after a surgical procedure. When the patient complained of postoperative complications, the doctor simply reassured the patient that everything was fine.
Rather than sending the patient into the emergency room for a hands-on evaluation, the failure to evaluate the patient's complaints have led to significant injury and sometimes death.
In some instances, the patient complained on a daily basis and told the doctor or his office staff.
Complaints of abdominal pain and discomfort did not trigger the doctor to bring the patient into their office for a follow-up examination. Nor was the patient ever sent to the emergency room.
In those cases, patient outcomes were not good.
The argument that I raise when that happens is that the doctor failed to timely recognize your bowel perforation.
I should step back for a moment and tell you how we would know you experienced a bowel perforation.
How do we know there was a bowel perforation?
There are two ways we would learn that a patient had a bowel perforation.
The first is when you present with such significant abdominal pain to the emergency room that you now need emergency abdominal surgery.
In all likelihood, you developed significant infection, known as sepsis.
You might have an acute and painful belly.
You might have rebound tenderness. That means there is pain when the doctor presses down on parts of your belly and pain when he releases hs hand from your belly.
In that case, it's critical that you have emergency abdominal surgery to find out why you are so sick.
Sometimes, diagnostic testing including x-rays, CAT scans and MRIs may show the presence of free air in your abdomen.
This can be a significant sign indicating that there is a leak somewhere within your bowel.
That is an abnormal finding requiring immediate surgical intervention.
The other way that we learn you had a bowel perforation is on autopsy.
In case you are unfamiliar with the term, it means a clinical examination of a person who died.
An autopsy attempts to determine why the patient died.
An autopsy is performed by medical doctor known as a pathologist.
His goal is to try and identify why you died.
In one case I handled, the gynecologist refused to believe he did anything wrong until I showed him the autopsy report. Take a look at the quick video below to learn what happened, then keep reading...
In cases involving bowel perforation leading to massive sepsis and death, the medical examiner will often be able to identify the precise location where your bowel perforation occurred.
He will often take photographs showing what the bowel perforation looked like and will also make observations about whether this happened recently or existed for a number of days.
If a doctor fails to timely recognize a bowel perforation during a surgical procedure, that often is a violation of the basic standards of medical and surgical care.
If the doctor recognized the injury at the time it happened and before the procedure was finished, then he could have called in a surgeon to repair the bowel injury.
When a doctor has failed to timely and properly recognize an injury to your bowel, we often can show that failing to timely diagnosis this condition was a cause of your worsening condition and massive sepsis leading to your death.
The mere fact that you woke up from your procedure and see a colonoscopy bag on your belly does not necessarily mean that a doctor violated the basic standards of medical care.
In all likelihood, it means that your bowel injury was recognized during your procedure and you needed to have it surgically repaired.
Since it was recognized intraoperatively (during the procedure), it would likely be challenging to show that there was any malpractice on the part of the physician.
However, if you were sent home and hours or days go by without any further follow-up in light of ongoing complaints, that may rise to the level of a departure from good and accepted medical care leading prompting you to bring a valid lawsuit.
To learn even more about how these failure to diagnose bowel injuries work, I invite you to watch a quick video below...
If you have questions about whether you may have a valid case involving a bowel perforation, I invite you to call me at 516-487-8207. I'd be happy to chat with you.