Case Overview
An otherwise healthy patient in their late 50s presented with indigestion. Imaging revealed distal narrowing of the common bile duct (CBD), and an ERCP was performed—with stent placement—to investigate. Shortly afterward, the patient developed severe abdominal pain, nausea, vomiting, and failure to tolerate oral intake.
Approximately 24 hours later, the patient went to a different emergency department, where a CT scan confirmed acute pancreatitis, and lipase exceeded 50× the upper limit of normal. They were treated with anti‑emetic and analgesic medications but notably received no IV fluids. They were discharged with instructions to follow up with their primary physician in two days.
With persistent symptoms, the patient contacted the ERCP facility and was advised to return for immediate admission. Upon return, IV fluids were not started until about 12 hours later, approximately 18 hours after diagnosis. Tragically, the patient deteriorated—developed hemorrhage—and ultimately passed away.
Allegations now focus on whether the 18‑hour delay in initiating IV fluids after diagnosis of acute pancreatitis constituted negligent management.
Why Early Fluid Resuscitation Matters in Acute Pancreatitis
It’s well established in the clinical literature that early fluid resuscitation is a cornerstone of acute pancreatitis care. Delayed fluids are associated with higher rates of organ failure, necrosis, and mortality.
One retrospective cohort study showed that patients who received less than one‑third of their 72‑hour fluid requirement within the first 24 hours had significantly higher mortality (18% vs. 0%). Additional data indicate early resuscitation reduces systemic inflammatory response (SIRS) and organ failure.
Thus, an 18‑hour delay from imaging diagnosis to initial IV resuscitation is outside standard emergency care, particularly when the patient presents with severe symptoms and markedly elevated lipase.
Legal and Procedural Considerations
- Establishing Standard of Care:
- Pancreatitis after ERCP is a well‑recognized risk, with an incidence ranging from 3% to 15%, and up to ~1% resulting in severe, potentially fatal outcomes.
- Emergency departments are expected to initiate early IV fluids promptly upon diagnosis, particularly when faced with severe disease markers and ongoing vomiting and intolerance.
- Breach and Causation:
- A failure to begin fluids until nearly 18 hours post‑diagnosis strongly suggests a breach.
- Given the literature linking delays to morbidity and mortality, proximate cause is plausible—i.e. the fatal hemorrhage and death may be connected to the delayed resuscitation.
- ERCP‑Specific Considerations:
- ERCP is an invasive procedure that carries known risks. Attorneys often pursue cases where the procedure may not have been indicated, or where post‑procedure monitoring and management is inadequate.
- According to legal sources, successful ERCP malpractice litigation often hinges on showing insufficient indication, poor execution, or failure to manage recognized complications (like pancreatitis).
