Colorectal cancer (CRC) is the third most common cause of cancer death in both men and women in the United States, and it ranks second when men and women are combined. Like most types of cancer, the risk of developing CRC increases with age, with roughly 88% of CRC cases occurring in adults ages 50 and older. The survival rate of CRC can be up to 90% when diagnosed at the localized stage, making early diagnosis particularly critical.
Colonoscopy provides a means for direct visual examination of the entire colon and rectum, and it’s the most commonly ordered test for the diagnosis and treatment of colon disorders, including cancer. Properly performed, colonoscopy is generally safe, accurate, and is well-tolerated.
In this case study, we will examine how a failed procedure and failure to follow up with the recommended and documented treatment plan resulted in a delay in diagnosing a patient with colon cancer, resulting in her untimely death. We’ll also provide risk management strategies to help avoid a similar situation.
A 75-year-old female patient was admitted to the hospital for complaints of abdominal pain. A CT scan was performed and reported as “obvious mass, no diverticulitis in proximal sigmoid colon.”
The next day, the patient was transferred to another hospital. A gastroenterologist was consulted and performed a flexible sigmoidoscopy. He was unable to advance the scope due to severe spasm, and he diagnosed the patient with acute sigmoid diverticulitis, recommending a colonoscopy be completed when her symptoms improved. On the next day, the patient was discharged from the hospital.
Nearly three weeks later, the patient was seen in follow up by the gastroenterologist at his office. At this time, the patient reported her symptoms had improved. Since a previous colonoscopy was performed six years ago, the gastroenterologist believed the procedure could be deferred.
Three months after the first hospitalization, the patient was readmitted to the hospital with complaints of nausea and vomiting, lower abdominal pain, and no bowel movement for four days. A CT scan revealed a bowel obstruction, and the insured consulted a general surgeon. On the following day, the patient was taken to surgery for an exploratory laparotomy and a sigmoid colon resection. A perforation was discovered in addition to adenocarcinoma of the sigmoid colon. The patient became septic and died two days later.
What Went Wrong?
A colonoscopy was indicated after the failed flexible sigmoidoscopy. The patient was seen in follow up three weeks after the failed procedure, and the gastroenterologist decided not to proceed with the original plan even though a colonoscopy was indicated. This test would have likely identified her colon cancer and would have allowed the patient to begin treatment. A definitive diagnosis of diverticulitis had not been made in the first hospitalization and, in fact, the patient did not have diverticulitis. The failure to diagnose cancer resulted in a delay with grave complications and ultimately death of the patient. In this case, the deferment of the colonoscopy resulted in progression of the adenocarcinoma, perforation leading to sepsis and death.
Risk Management Takeaways:
- Providers should follow the recommended guidelines for screening vs. diagnostic colonoscopy follow up, especially when patients are symptomatic. In this instance, when the patient returned for the follow up visit and was feeling better, the colonoscopy should have been scheduled and performed to determine the status of the gastrointestinal tract for signs of disease.
- Healthcare providers should pay close attention to patients who are symptomatic.
- Physicians should review the previous treatment plans to ensure appropriate action is taken during the current visit.
To evaluate risk within your practice, Curi members are invited to take our Self Risk Assessments (SRAs), including the newly available GI SRA. Members can click here to begin their SRA today and receive actionable insights and suggestions as developed by our expert team of risk management professionals.
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