Here’s another case from Medical Malpractice Insights – Learning from Lawsuits, a monthly email newsletter for ED physicians. The goal of MMI-LFL is to improve patient safety, educate physicians and reduce the cost and stress of medical malpractice lawsuits. To opt in to the free subscriber list, click here.
Chuck Pilcher, MD, FACEP
Editor, Med Mal Insights
Splenectomy patients at greater risk of sepsis
Not a malpractice case, but death from dog bite is a good reminder
Facts: A 57-year-old male 38 years post-splenectomy for trauma stops by his mini-storage unit. While there he is bitten on the finger by the unrestrained dog of another unit occupant. He debates seeking treatment until he develops severe LEG pain the following day and goes to the ED. There he immediately informs the ED physician of his remote splenectomy. He is found to have a pulseless R foot. Sepsis is quickly suspected and appropriate evaluation and treatment begun. During an angiogram a few hours after presentation, he becomes mottled and hypotensive. Further tests reveal DIC due to overwhelming sepsis. Blood cultures grow Capnocytophaga canimorsus, a bacterium common in the canine mouth. Despite excellent medical care, the patient deteriorates rapidly and dies of multi-organ failure 9 days later. A lawsuit is filed against the owner of the dog.
Plaintiff: Veterinary records show that your dog is a “known biter.” In fact, your dog even bit another person at the storage facility earlier the same day. Yet you continued to allow him to run loose and bite me. The germs got into my bloodstream, caused sepsis and I died. It’s your fault.
Defense: You asked for it. We think you tried to pet the dog and it bit you. (This fact was disputed). You should have been more careful, especially since you know that your splenectomy puts you at greater risk for infection.
Result: Large pre-trial settlement against dog owner.
Takeaways:
- This is a case of “Overwhelming Post-Spenectomy Infection (OPSI). Yes, it is not a malpractice case. Yes, the patient received excellent medical care. And yes, most patients who have had a splenectomy report that fact to their health care providers early and often, as in this case. The “takeaway” which allowed this patient to get the best care possible is that caregivers paid attention to the history.
- Regardless of how long ago one’s spleen was removed, post-splenectomy patients are high risk.
- A simple dog bite can progress very rapidly to sepsis and death.
- Don’t own dogs that bite people. It cost this dog owner nearly $1 million.
References:
Overwhelming Post-splenectomy Infection (OPSI). Morgan TL, Tomich EB, J Emerg Med. 2012;43(4):758-763. Access via Medscape eMedicine here.
