re: Man dies in Destin after surgeon removes liver instead of spleen

this might be the way i want to go out.

go to sleep and just never wake up. Family should have no more money problems.

quote:

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This thread de-livers.

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And they still have some ex-spleening to do.

I saw the OP note. This is a terrible tragedy, but I suspect there is much more to it than simply a bumbling surgeon looking at the liver, thinking it is spleen and taking it out. I think the postmortem is going to be critical here, and unfortunately most of us won't know the result, though I'm very curious myself particularly from a system failure point of view.

Recreating events, sounds like guy had symptomatic LUQ pain, with imaging suggesting markedly enlarged spleen in addition to hemoperitoneum (free blood in the peritoneal cavity) in the context of a declining hemoglobin in a morbidly obese patient that perhaps did not have a ton of reserve to work with from the get go.

Now, armchair quarterbacking, the first question I have would be was a hand-assisted laparoscopic approach be the best approach? Hard to say, I 100% understand wanting to make it happen laparoscopically in the morbidly obese patient, but if there is a pretty reasonable expectation of significant hemoperitoneum, perhaps that was not the right call and perhaps exposure through a generous incision may have been the right move initially (much easier call in retrospect). Secondly, in the op note, there is a notation of a "splenic laceration" - gives me pause as to whether or not the splenic lac was actually a liver lac, and also brings in the possibility that the injury occured establishing laparoscopic access or in the process of taking down adhesions with the operators hand as is also described in the op note.

Further described is a "splenic artery aneurysm" (which totally make sense in the clinical picture) which apparently ruptured (or maybe was ruptured in the process), which as one would expect cause catastrophic hemorrhage and then all bets are off as far as being able to gain exposure and actually not only control the hemorrhage, but clamp the correctly identified vascular structure in the process. The question is did the surgeon just willy nilly do something stupid, or given a bad situation, not take a beat (never seems like you have one when you're in the weeds) and panic? This of course goes back to ability (natural) and training, which can overcome some (not all) deficiencies, but every surgeon has to know his or her limits and operate accordingly within those limitations. I think the best recognize this, the worst never do despite signs both internal and external, unfortunately oftentimes at least until something like this happens.

At any rate, the pathology doesn't lie, and tells the tale that in either haste, or purely in error, the organ removed was a chunk of liver instead of spleen, which is of course damning. Not that this matters, but it wasn't likely the liver chunk being removed (as the lead on this story would seem to suggest), but rather the massive hemorrhage preceding this event that led to this patient's demise, not that this makes anything better.

This whole thing is a freaking tragedy on both a human level and a system level and these are the kind of things that give the whole medical establishment a black eye, even appropriately trained physicians, with appropriate skills, recognizing their limitations and operating in good faith.

The Op note and the path report are published, and I am not sure if it is appropriate for me to publish it here, but if one were to look on "X" for @medmalreviewer, one can view for oneself.

I am not a general surgeon, but rather practice in another surgical specialty with extensive MIS (minimally invasive surgery) experience and this is simply to shed some insight on what might have happened here. I will add one more thing, I went to an Allopathic (MD) mainstream US med school, and will admit in my formative years was perhaps a bit biased against Osteopathic (DO) grads, but have come to realize over the years that I have seen many DO colleagues in multiple specialties that I would trust my life with, so I don't know if this can be laid at that doorstep.

I had qualms about posting on this, but but how I take care of people is very important to me, and every bit as important, how our system(s) deliver care is very important to me. I think the medical industry can take a lot from the airline industry in un-emotionally and factually examining failures in order to prevent such things going forward.

edited for grammar

Talked to one of my Gen surg colleagues today in the lounge and he said exactly the same thing, almost to a tee.

No doubt the guy fricked up. However, I'm sure the truth is nowhere near what the plantif attorney is leading on.

Reminds me of the doctor scene in Spies Like Us when they are about to operate on the village leader.