Case Study- ERCP complications

Case Study: ERCP Complications
59 year-old DW had a Foley catheter inserted for an unrelated prostate issue. On xx/03/xxxx, he was
admitted with a urinary catheter problem and was diagnosed with gallstones and elevated liver enzymes.
Doctors removed the stones from the common bile duct and DW was discharged. Later that day, DW
returned to the ER complaining of weakness. Radiology reports revealed minimal left lower lobe
infiltration that was not present on xx/03/xxxx. On xx/09/xxxx, a CT of the abdomen and pelvis showed
hemorrhagic pancreatitis with a pseudoaneurysm, probably of the gastro-duodenal artery. Doctors
successfully coiled the pseudoaneurysm and DW was discharged in a stable condition.
Our client wanted us to analyze the medical records to detect whether or not a case could be made for a
breach in the standard of care.
Trivent’s gastroenterologists reviewed DW’s medical records, focusing on the initial ERCP procedure
performed to remove the gallstones.
The Solution:
As per the client’s needs, Med-Defense delivered the following services:
1. Medical Chronology – An organized timeline of the patient’s medical records, highlighting the
ERCP procedure with all significant details.
2. Medical Opinion – A detailed Q&A opinion in which we answered most of the questions
relating to the ERCP procedure. We also provided references to supportive medical literature.
Indications for ERCP have been proposed in consensus statements and guidelines. The need for
recognizing accepted indications for ERCP is underscored by the observation that malpractice litigation
surrounding ERCP frequently involves disputes regarding the appropriateness of the indications. There is
a general consensus that ERCP procedures should be performed, with sound indications, by trained
endoscopists using standard techniques, with well-documented patient informed consent, and
communication before and after the procedure.
In DW’s scenario, ERCP was performed after considering the proper indications, contraindications
and consent.
ERCP with a sphincterotomy and stone removal is an appropriate course of therapy in choledocholithiasis
with jaundice, a dilated common bile duct, acute pancreatitis, or cholangitis.
Ultimately, Trivent noted that there was no deviation from the standard of care that would have led to the
patient’s complications.