Medico-legal implications for the colon perforation during colonoscopy

Abstract

Aims: Colon perforation is the most serious complication of colonoscopy, and tends to be considered as malpractice. The aim of this study was to identify the characteristics and causes of medical accidents by analyzing lawsuit cases on colon perforation during colonoscopy. Methods: We collected judgment results that were ruled from 2005 to 2015 using the keyword of 'colonoscopy' in the 'Korea's Written Judgment Public Reading System' of the Supreme Court, and extracted the cases of colon perforation. Characteristics of medical accidents and the decisions of courts were analyzed from written judgments. Results: Twenty-two lawsuits were analyzed. Most cases were ruled in favor of the plaintiff (n=20). The allegations against defendants, filed by the plaintiffs, were the performance error (n=22), the improper monitoring after colonoscopy (n=7), and the lack of informed consent (n=8). The median compensation was 9,335.47 US dollar, this is about 130 times the cost of a single colonoscopy in Korea. The greater the intestinal damage, the greater the amount of compensation (p=0.016). The time interval from procedure to diagnosis of perforation was most frequently 24 hours later (n=9). Conclusions: It is important to educate patients fully about the symptoms of colon perforation and to guide them to contact medical institutions immediately when symptoms occur. In addition, doctors should explain sufficiently the possibility of perforation before colonoscopy to the patients, not caregiver, and get an informed consent. What's already known about this topic?Medical accidents can be experienced by any doctor, and especially gastroenterologists are always being exposed to risk of developing perforation during colonoscopy. What does this article add?This is the first study to analyze the characteristics of lawsuit cases of the colon perforation. Most of the lawsuit cases related to colonoscopic perforation were judged in favor of the plaintiff, and the greater the intestinal damage, the greater the amount of compensation. The court declared the doctor's negligence, but reduced liability for damages if appropriate actions were taken.

Effects of surgical treatment on 24465 patients with intestinal perforation complicated with septic shock in tertiary hospitals in China from 2017 to 2020: a systematic review

“…The median charge for a septic shock hospitalization of a large academic hospital was $98,583 in the United States (23). The median compensation for the colon perforation during colonoscopy was $9335.47 (24). In our study, the median hospital charges with intestinal perforation complicated with septic shock in tertiary hospitals in China are 50,000 yuan, far more than the 9,800 yuan per person spent on hospitalization in 2019 in China.…”