Wednesday, February 10, 2010
Senator Murtha Dies Following Gallbladder Surgery
First of all, condolences to the family of Senator John Murtha who died recently following complications of gallbladder surgery. My thoughts are also with the surgeon in Maryland who performed the laparoscopic cholecystectomy. The death of a patient following routine elective surgery represents every surgeon's worst nightmare. The fact that it happened to a prominent American politician just exacerbates the stress and despair that the surgeon is probably feeling right now.
But I wanted to respond to a clip I watched earlier today from ABC News. In the video, Diane Sawyer (I know, you're supposed to say the lovely Diane Sawyer) interviews the ABC medical correspondent Richard Bessler, MD (trained as a pediatrician) about the possible causes of Senator Murtha's unfortunate outcome. Based on his explanations, she may as well have asked a 1st year medical student. According to Dr Bessler:
"to do this surgery, to remove the gallbladder, you need to separate it from the large intestine.....what may have happened, there may have been a small nick in the large intestine"
Now, what I think Dr Bessler is describing is an entity called a cholecysto-colonic fistula, which is very rare. For one thing, there are no natural attachments between the gallbladder and the large intestine. Certainly in cases of acute inflammation it is possible that an abnormal adhesion may form between the colon and gallbladder but these adhesions are typically very flimsy and easily divided; development of an actual connection between gallbladder and colon only occurs in cases of chronic inflammation over years and years. The likelihood that Murtha died from an injury to the colon is extremely low, statistically.
Most likely, Senator Murtha developed some sort of bile leak, either from the cystic duct stump or an actual injury to the common bile duct itself. Uncontained bile leakage throughout the abdominal cavity can lead to peritonitis, systemic inflammatory response syndrome (SIRS) and subsequent multiple organ failure/death. If there was a bowel injury, the most common source would be either the duodenum (often adherent to the neck of the gallbladder during the acute phase) or else small bowel adherent to the abdominal wall down by the umbilical port site (in placing the intial port, one can sometimes unwittingly cut into intestine that is stuck to the abdominal wall). Injury to the hepatic flexure of the colon would be much lower on my differential of possible causes.
I'm irritated because these are obvious points I'm making (from a surgical perspective). And here we have ABC News relying on the "expert testimony" of a pediatrician who works for the CDC. Dr Bessler, bless his heart, is obviously trying. You can tell that he looked at a human atlas and saw that the colon seems to be pretty close to the gallbladder. But his hypothesis is detached from any semblance of statistical likelihood. Why didn't ABC News ask, I don't know, maybe a SURGEON what the likely causes of Murtha's demise were? Is that asking too much? I know the guy is good looking and seems to handle himself well in front of the camera, but doesn't a news organization as influential as ABC News have an obligation to get their basic facts straight?
On another note.....posting has obviously been light. Probably will stay that way. Busy work and a crawling baby force a guy to have to eliminate certain indulgements.