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Houston hospital discharges man with post-operative internal bleeding

Internal bleeding can lead to infection and sepsis

A middle-aged man was visiting Houston, Texas for work when he suddenly had severe abdominal pain. Let’s call him Leonard.

After the pain, nausea, and vomiting didn’t go away for two days, Leonard went to a local hospital emergency room (ER) to get checked out. The ER physician ordered an abdominal CT scan, which showed that Leonard had acute appendicitis, which fortunately had not perforated or formed an abscess.

Leonard was admitted to the hospital and seen by a general surgeon the same day, who decided to take him to the operating room to perform a laparoscopic appendectomy.  Laparoscopic procedures are sometimes described as minimally invasive because they don’t involve the large incisions of traditional open surgery.

In the operating room, the general surgeon encountered lots of inflammation, which made it hard to identify the structures. The surgeon saw lots of thickened tissues, redness, inflammation, and pus (purulence) on the surfaces of the appendix. After removing the appendix, the surgeon finished the operation and sent Leonard back to the floor.

The next day, Leonard didn’t feel well. A repeat abdominal CT scan showed new findings, and the radiologist couldn’t exclude the possibility of a small bowel obstruction or ileus (muscles of the intestines temporarily not contracting). Over the course of the day, he didn’t improve, and blood work showed low hemoglobin and hematocrit levels, which could be consistent with a bleed. The doctor ordered a blood transfusion.

The next morning, the surgeon decided to take him back to the operating room for exploratory surgery, also done laparoscopically. During the surgery, the surgeon found what she described as a moderate amount of small blood clots in the abdomen, which she removed. The surgeon noted that she was unable to find the source of the bleeding.

Over the next few days, Leonard felt somewhat better but had extensive bruising on his left flank and scrotum. Despite these symptoms, and recent blood work showing hemoglobin and hematocrit on a downward trend, he was discharged from the hospital and sent home.

Two days later, Leonard returned to a hometown hospital ER because of abdominal pain that he rated 8/10. He showed the ER physician the extensive bruising that was still prominent on his left flank and scrotum. He also shared that he had gained 15 pounds over the last week.

The ER doctor ordered a CT of the abdomen, which showed a large amount of hemorrhaging. Yet, his lab work showed his hemoglobin was stable—it had actually increased since he was discharged from the Texas hospital. Leonard was taken back to surgery, where the surgeon discovered a large, foul-smelling dark hematoma. The operative report noted the removal of 400 cc of dark blood. The second surgeon didn’t identify the source of the bleeding either.

Unfortunately, Leonard had a terrible post-operative course after he returned home. He developed a fistula, which was an opening between his intestines and the skin at the site of his surgical wound. That meant another repair surgery, which left him with a temporary colostomy bag. That meant that his bowel contents leaked through to the skin. Leonard also had bouts of infection and life-threatening sepsis.

Surgical bleeding

The medical literature describes at least three types of bleeding that can come to pass around the time of surgery:

• Primary bleeding occurs during surgery. The standard of care requires surgeons to diligently search for the source of bleeding and if found correct it.

• Reactive bleeding happens within the first day after surgery. Sometimes this bleeding develops after a patient’s hemodynamic status normalizes following surgery.

• Secondary bleeding presents a week or so after surgery, as a result of an infection damaging a blood vessel.

The general surgery expert that we consulted in Leonard’s case concluded that the surgeon likely didn’t identify primary bleeding that occurred during his initial appendectomy surgery. The fact that he was bleeding was evident when the general surgeon took him back to the operating room for an exploratory laparotomy.

Although the general surgeon removed the old blood and clots that she located through the minimally-invasive second surgery, she was unable to identify the source of the bleeding. The general surgery expert we retained believes that, under the circumstances, the standard of care required the surgeon to convert to an open procedure to gain a better view of the abdomen.

Prior to his discharge from the Houston hospital, Leonard showed ample signs that he was unstable and not ready for discharge. He had extensive bruising and his bloodwork was trending in the wrong direction. We believe that between his second and third surgeries, Leonard continued to slowly bleed, which led to the massive hematoma that was found in his third trip to the operating room.

If the bleeding had been identified and surgically treated in Houston, our expert believes that Leonard’s infection, sepsis, and serious disabling injuries would likely have been avoided.

If you’ve been seriously injured because of poor post-operative care in Texas, then contact a top-rated, experienced Texas medical malpractice attorney for a free consultation about your potential case.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.


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