Case #1046: Aortic Dissection
On February 15, the Plaintiff’s Decedent was a 56 year old male with a past medical history significant for hypertension. He presented to the Defendant Hospital via ambulance in a diaphoretic state with complaints of near syncope as well as back pain.
On admission to the emergency department, the Plaintiff’s Decedent became hypotensive. A sonogram was obtained, the results of which inaccurately diagnosed an abdominal aortic aneurysm. The documented differential diagnosis included a ruptured abdominal aortic aneurysm or aortic dissection. A stat vascular consultation was obtained. It is alleged that the vascular consult presumed a ruptured abdominal aortic aneurysm with no additional tests or studies performed within the standards of care. Accordingly, the Plaintiff’s Decedent was simply transported to an operating room for an exploratory laparotomy at approximately 4:15 p.m. on February 15, 2005. At that time, the Plaintiff’s Decedent was opened and explored in the area of his abdomen. All areas were appreciated to be normal — with no abnormalities. The abdominal aorta was found to be of normal caliber, appearance, and feeling. No free fluid, blood or other abnormalities were found, notwithstanding further exploration of the abdomen.
As a result, the exploratory laparotomy yielded absolutely no abnormalities or diagnosis which could have been responsible for the Plaintiff’s Decedent’s presentation. Tragically, and in ongoing violation of the standards of care, the Defendant Hospital’s personnel abandoned other required tests and studies to rule in or rule out conditions found on the differential diagnosis which included, specifically, aortic dissection. It is alleged that such a dissection of the aorta is an absolute medical and surgical emergency. When the exploratory laparotomy yielded no results whatsoever, the Defendant Hospital’s personnel were obligated to go forward with stat studies to rule in or rule out aortic dissection. They failed to do so in continuing violation of the standards of care.
After the exploratory laparotomy, the Plaintiff’s Decedent was simply closed and transferred to the Intensive Care Unit with no diagnosis, and no intervention. As the night passed, the Plaintiff’s Decedent became more acidotic, hyperlactemic and hypertensive, with compromised respiration. Amazingly, the Plaintiff’s Decedent was taken back to the operating room for additional surgery — a subtotal colectomy. However, no tests or studies were conducted to rule in or rule out aortic dissection as mandated by the standards of care.
Upon re-entry into the Decedent’s abdomen, his right transverse colon and left colon were noted to be gangrenous. Additionally, the small bowel was hypoperfused — all due to the ongoing presence of an aortic dissection and malperfusion which was permitted to progress with no diagnosis or intervention. During the surgery, the Plaintiff’s Decedent developed a coagulopathy and active bleeding — again, due to the ongoing missed diagnosis of the aortic dissection. However, due to the missed diagnosis of the aortic dissection and the resulting hemodynamic instability, the abdomen was simply packed and the Decedent was transferred back to the Surgical Intensive Care Unit in critical condition — still with no diagnosis and no meaningful intervention for the aortic dissection.
On February 16, at approximately 11:00 a.m., a transesophageal echocardiogram was finally completed. Its results confirmed the presence of the aortic dissection. Although an emergent cardiac surgical consultation was obtained. Notwithstanding ongoing attempts at resuscitative efforts, the Plaintiff’s Decedent continued to spiral in a downward course due to the misdiagnosed aortic dissection, and finally succumbed on February 16, at approximately 6:24 p.m.
It is alleged that had the Defendant Hospital’s personnel acted in accordance with the standards of care, the transesophageal echocardiogram or even a simple CT scan would have been performed which would have diagnosed the presence of the aortic dissection in a timely fashion. Thereafter, the Plaintiff’s Decedent would have underwent surgery to repair same, and would have returned to his home to rejoin his family and resume his normal activities. However, as the direct and proximate result of the ongoing negligence of hospital personnel, the Plaintiff’s Decedent was simply left to languish with the aortic dissection being permitted to extend and ultimately claim his life.