Medical malpractice involving radiologic colon examinations: a review of 38 recent cases

Intraperitoneal Barium From Gastrointestinal Perforations: Reassessment of the Prognosis and Long-Term Effects

OBJECTIVE. The purpose of this study was to reassess the outcome and potential consequences of intraperitoneal barium leakage during radiologic evaluation of the gastrointestinal tract. MATERIALS AND METHODS. This retrospective study included 18 patients who had significant intraperitoneal leakage of barium from gastrointestinal perforations that were not suspected or diagnosed before the radiologic procedures. This complication occurred during a barium enema examination in nine patients, an upper gastrointestinal study in seven, and a small bowel series in two patients. All patients underwent urgent laparotomy for repair of perforation, with vigorous peritoneal lavage and antibiotic therapy. RESULTS. All patients had an uneventful recovery and were followed for 4-17 years (mean, 8.5 years). Radiographs obtained during this interval showed that a significant amount of residual barium was retained in the abdominal cavity. Six patients had a total of 10 subsequent abdominal operations for unrelated conditions, and some had developed barium granulomas and peritoneal adhesions. However, none of the patients in this series experienced intestinal obstruction or any clinical symptoms related to barium deposits in the abdominal cavity. CONCLUSION. Intraperitoneal leakage of barium is a rare complication of radiologic gastrointestinal examinations, and this series of 18 cases reflects 3 decades of experience at two major medical centers. The presented data indicate that the commonly held and perpetuated concept about the high rate of morbidity and mortality of this complication would not be valid in the modern era of medical and surgical management.

Medical disciplinary jurisprudence in alleged malpractice in radiology: 10-year Dutch experience

PURPOSE

To systematically investigate the frequency and types of allegations related to radiology practice handled by the Dutch Medical Disciplinary Court in the past 10 years.

METHODS

The Dutch Medical Disciplinary Court database was searched for verdicts concerning radiology practice between 2010 and 2019. The association between the number of verdicts and time (years) was assessed by Spearman's rho. Other data were summarized using descriptive statistics.

RESULTS

There were 48 verdicts (mean 4.8 per year). There was no significant association between the number of verdicts and time (Spearman's rho < 0.001, p = 0.99). Most allegations were in breast imaging and musculoskeletal radiology (each 18.8%), followed by interventional radiology, head and neck imaging, and abdominal imaging (each 12.5%), neuroradiology and vascular imaging (each 10.4%), and chest imaging (4.2%). There were 46 allegations against radiologists (95.8%) and 2 against residents (4.2%). The most common allegation (37.5%) was error in diagnosis. In 20.8% of verdicts, the allegation was judged (partially) founded; disciplinary measures were warnings (n = 8) and reprimands (n = 2). An appeal was submitted by the patient in 11 cases and by the radiologist in 3 cases. All appeals by patients were rejected, whereas 2 of the 3 appeals by radiologists were granted and previously imposed disciplinary measures were reversed.

CONCLUSION

Allegations against radiologists at the Dutch Medical Disciplinary Court are relatively few, their number has remained stable over the past 10 years, and a minority were judged to be (partially) founded. We can learn from the cases presented in this article, which may improve patient care.

KEY POINTS

• The frequency of allegations against radiologists at the Dutch Medical Disciplinary Court is relatively low and has not exhibited any temporal change over the past 10 years. • These allegations reflect patient dissatisfaction, but this infrequently equals malpractice. • Knowledge of the circumstances under which these allegations have arisen may improve patient care.

CT findings of latrogenic complications following gastrointestinal endoluminal procedures

Abdominal CT, a simple and safe imaging modality, plays an important role in evaluating patients suspected of having abdominal complications following nonsurgical gastrointestinal procedures, to accurately determine the presence or absence of such insults. This pictorial article reviews and demonstrates the CT findings of various complications following upper endoscopy, percutaneous endoscopic gastrostomy, endoscopic retrograde cholangiopancreatography, endoscopic US, colonoscopy, and enemas (barium as well as cleansing).

Unexpected finding of barium sulphate on the surface of a microspinal catheter

During a study with a scanning electron microscope to evaluate the structure of microspinal catheter after its removal from subarachnoid space, we found an unusual case. The observation with the microscope of the tip of a catheter removed at the end of an operation for hip replacement in a old female showed the presence of grounded particles with a crystal shape covering the outer surface. Further analysis of this material with an Energy-Dispersive Spectrometer (EDS) showed that it was barium. The patient performed a large bowel barium enema 8 months earlier for a painful syndrome to the lower abdomen. Authors rule out the contamination from the skin and suggest two possible mechanisms of passage of barium from blood to cerebrospinal fluid (CSF) and so to the surface of the catheter.

Colon cancer at barium enema examination and colonoscopy: a study from the county of Hordaland, Norway

PURPOSE

To evaluate the efficacy of barium enema examination as routinely performed in the detection of colon cancer in the inhabitants of a well-defined and circumscribed geographic region.

MATERIALS AND METHODS

The study comprised 571 patients with histopathologically verified colon cancer during 1990-1993 from the county of Hordaland. The barium enema examination results were reviewed retrospectively.

RESULTS

The correct diagnosis was reached in 351 cases (sensitivity, 90.9%) in 386 tumor locations on the basis of the results of 381 barium enema examinations. Cancer or an important precancerous lesion was overlooked in 26 cases (6.7%), and the examination was not feasible in nine cases (2.3%). The correct diagnosis was reached in 172 cases (sensitivity, 80.0%) in patients with 215 tumor locations on the basis of the results of 213 colonoscopies. Cancer or an important precancerous lesion was overlooked in 13 cases (6.0%). The examination was technically not successful (i.e., the affected area was not reached with the scope) in 30 cases (13.9%).

CONCLUSION

Barium enema examination is valuable in the diagnosis of colon cancer and compares favorably with colonoscopy. The main reason for missed radiologic diagnosis is failure to observe important lesions visible on the radiographs.