[Plaintiff's Statement]
On December 9, 2015, the plaintiff went to the defendant for a caesarean section due to her full-term pregnancy, and everything returned to normal after the operation. On December 12, the plaintiff suddenly suffered severe abdominal pain and was diagnosed with acute cholecystitis stones by the defendant's 10th general surgery. Later, he was transferred to the 10th Department of General Surgery, where he underwent laparoscopic cholecystectomy, biliary tract exploration, stone removal, and T-tube drainage on December 13, 2015.
After the operation, the plaintiff had been distended and had abdominal pain. The T-tube has not been drained. Although I went to the doctor on call many times, the doctor told me that the pain was caused by abdominal distension and not gas, and it had nothing to do with surgery. The plaintiff has been suffering from pain since then, and the defendant's doctor has only given him "strong pain" and "demerol" to relieve the pain, but has never given a comprehensive examination.
By the evening of December 21, the plaintiff had a sudden increase in abdominal drainage tubes and a bile overflow from the T tube. CT scan showed that the plaintiff had a large amount of fluid in his abdomen, pelvis and liver, and on the afternoon of December 22, he underwent puncture and drainage, and 2,800 ml of bile fluid was discharged that night. On the morning of December 24, the plaintiff went to the defendant's hospital for "transgastric endoscopic drainage".
Since the defendant did not use general anesthesia, the operation could not be performed, and the laparotomy was performed in the afternoon of the same day, during which it was found that the plaintiff's abdominal cavity had been infected in a large area, and the bile duct had been enclosed by the T duct with a large incision, which could not be repaired due to the long-term bile immersion and decay, and only a part of the bile duct could be removed for biliary-intestinal anastomosis. He was discharged from the hospital on 7 January 2016.
[Plaintiff's opinion]
After being discharged from the hospital, the plaintiff was very weak and not only could not breastfeed the baby, but also suffered from long-term abdominal distention, constipation, and often suffered from symptoms such as indigestion and intermittent severe abdominal pain. Due to a series of serious mistakes in the defendant's medical acts, the plaintiff's biliary fistula damage continued to expand. Claim: The defendant is required to bear the main liability for medical damages and compensate the plaintiff a total of 437386 yuan.
[Defendant's argument]
The cause of bile leakage is unknown, and it takes time and examination to find out the cause, and laparotomy cannot be done as soon as bile leakage occurs. In addition, after the discovery of bile leakage, we are prepared to take ENBD intrabiliary drainage to reduce intrabiliary pressure, and the vast majority of bile leakage can be effectively treated through ENBD drainage and abdominal drainage in clinical practice.
However, the patient could not tolerate ENBD intrabiliary drainage, and the above conservative treatment was ineffective, and emergency surgery was performed in time with good results. It is not uncommon in clinical practice to have low postoperative T tube drainage, and some patients even have no postoperative T tube drainage.
The reasons are also varied, such as the distal biliary tract is unobstructed, the T tube drainage can be less or even none, and although the patient has less T tube drainage after surgery, there is no jaundice, there is no special abnormality in the repeated laboratory tests of liver function 11 times, and the intrahepatic and extrahepatic bile ducts are not dilated on abdominal CT reexamination, so the low drainage of the T tube does not mean that the T tube fell off at that time.
Due to the short postoperative time of the local bile duct, the inflammation is particularly severe, and it cannot be repaired, and the forced repair will definitely cause bile leakage and bile duct stricture and cholangitis recurrence, and the result must be another operation for bile duct jejunal Rou-en-Y surgery, so we chose the above surgery, and the patient was quickly cured and discharged from the hospital after surgery.
【Appraisal Results】
1. In this case, a hospital performed laparoscopic cholecystectomy, common bile duct exploration, and T-tube drainage on Xu, and the postoperative T-tube drainage was abnormal, and the patient had unbearable repeated abdominal pain, but the doctor did not pay enough attention to the patient's abnormal situation, failed to fully foresee and avoid the dangerous consequences, and did not deal with it in a timely manner, and was at fault;
2. There is a causal relationship between the medical fault and Xu's damage consequences (aggravation of the disease, prolongation of the course of the disease, and final biliary-intestinal anastomosis), and the medical fault is the main cause (the cause force is intended to be 70%-80%).
3. The appraised person Xu is currently suffering from biliary-intestinal anastomosis surgery, and combined with his relevant treatment, there is no relevant evidence of repeated biliary tract infections, and considering that the relevant CT shows the presence of intrahepatic bile duct stones or calcifications, his current condition constitutes an eighth-grade disability.
【Verdict】
On February 27, 2024, it was decided that the defendant hospital should bear 70% of the liability and compensate the plaintiff Xu 289,545.9 yuan.
[Excerpt from judicial adjudication cases]