IV Case in Point
Illustrated Verdict shares case examples from our archives to show how a visual strategy can support the defense effort. We hope that it is of value in your practice as you develop your defense strategies on behalf of health care providers. Please feel free to forward it to colleagues or clients.

About Us
IV is a leading provider of demonstrative evidence for the defense of medical malpractice claims. Our team of medical illustrators consults with defense teams to educate the lay jury audience about the complexities of medical care. We do this by developing a visual strategy with expert witnesses including high-quality case-specific medical illustrations, x-ray enhancements, and multimedia presentations. IV receives judgment for the defense in over 94% of the cases we participate in, as compared to the national average of 73%. Additionally, insurers who supply us with their trial list enjoy a win rate of up to 97%.
To learn more, e-mail us or call 617-530-1001.
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Case In Point Library
Click to view other editions:

Case In Point Library Page

Pregnancy and Delivery:
Fetal Assessment 2009v1
Shoulder Dystocia 2009v3
MVA Leads to Fetal Demise 2010v4
Fetal Descent Stalled 2010v5
Shoulder Dystocia / Erb's 2011v4
Fetal Tracings / Hypoxic Injury? 2013v1

Heart:
Coronary Artery Disease 2009v5
CAD / Recurrent MI 2010v1
Aortic Valve Replacement 2011v1

Lungs:
Stroke After Lung Surgery 2009v2
PE / Infection 2010v3
PE Following Roux En Y 2012v1
Intubation / Macklin Effect 2012v4
Lung Cancer vs. Infection 2015v3

Female Pelvis:
Hysterectomy / Fistula 2011v9
Hysterectomy / Ureter Injury 2010v2
Hysterectomy / Kinked Ureter 2010v8
Diag Lap / Bowel Injury 2012v3
Cervical Cancer 2013v3
Endometrial Cancer 2014v1

Male Pelvis:
Bladder Cancer 2013v2

Digestive System:
Gastric Bypass 2009v6
Recurrent Hiatal Hernia 2009v8
Right Colectomy / Leak 2010v7
Gastric Bypass / Volvulus 2011v2
Nissen Fundoplication 2011v3
Large Hiatal Hernia 2013v5
Necrotizing Enterocolitis 2013v7
Arrest during ERCP 2015v4
Diverticulitis Complications 2015v5

Abdomen:
Spleen Injury and Bleed 2009v4
Bleed Following Lithotripsy 2012v2
Lap Cholecystectomy 2012v5
Bowel Injury Lap Ovarian Cyst Removal 2013v6
LapChole - Hepatic Duct Injury2015v1

Orthopedic:
Partial Hip Replacement 2010v6

Vasculature:
tPA Infusion 2009v7
Vertebral A. Coil Embolization 2015v7

Head and Neck:
Bell's Palsy 2013v4
Tongue Cancer 2014v2
Chiari I - Vision Loss 2015v2

Judgment for the Defense
Internal Hernia Following
Laparoscopic Right Colectomy

http://www.illustratedverdict.com/projectreview/IV/IV_v2_2010web/2624m7changed_small.jpg

The plaintiff underwent a laparoscopic right colectomy to remove a recurrent sessile neoplastic lesion that was not amenable to safe colonoscopic removal due to its size and configuration. The operation was uneventful, and the postoperative recovery was also initially without incident. Worsening clinical findings, however, resulted in further evaluation, including a CT scan. The radiologic findings, coupled with the patient’s clinical condition, necessitated a return to the operating room. Exploration revealed an internal hernia along with an anastomotic leak and associated abscess—known complications of the original procedure. The defendant resected the previous ileocolic anastomosis and created a new ileocolic anastomosis.  The patient’s postoperative recovery was long and complicated, involving two subsequent major procedures and several minor procedures, but ultimately he recovered fully.


PLAINTIFF'S CLAIM:

The plaintiff believed the defendant failed to follow standard of care by not closing the mesenteric defect between the terminal ileum and the transverse colon.  Plaintiff’s lawyers argued that the defect allowed an internal hernia to occur, resulting in an anastomotic leak and subsequent complications.  The plaintiff maintained that failure to close the mesenteric defect was the "sole cause" of his difficult and complicated recovery from the laparoscopic right colectomy.



DEFENSE'S ARGUMENT:

Resection of the plaintiff’s neoplastic disease created a defect in the mesentery of the bowel. Defense experts testified that the standard of care does not require routine closure of the mesentery after performing a right colectomy.  They also testified that an anastomotic leak is  known to be a serious possible complication of this type of surgery.  Furthermore, during the original procedure, the defendant followed standard practice for minimizing the risk of an anastomotic leak, using proven, safe techniques to perform the anastomosis to ensure there was no tension between the two segments of intestine and that each margin was healthy and viable.


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VISUAL STRATEGY:

Collaborating with the defendant and his attorney, IV created illustrations to help convey his recollection of events to the jury. 

IV started with an illustration of the normal anatomy of the abdomenand an illustration clarifying the anatomy of the mesentery and colon

Another diagram illustrated the laparoscopic port positions

An additional illustration detailed the relevant surgical anatomy and, specifically, the right colon and mesentery removed during the right colectomy

The anastomosis created between the ileum and colon following excision of the specimen was depicted on another illustration board. 

The last board showed the internal hernia that the defendant believed led to the anastomotic leak.

This series of illustrations helped the defense successfully convey the following key points to the jury:  

  • The surgery was done correctly and followed the standard of care.
  • Anastomotic leaks are a known risk of these procedures.
  • Although its occurrence in this case was unfortunate, the anastomotic leak was recognized and corrected promptly and appropriately.


RESULT:

The jury found in favor of the defense. 

"We received a defense verdict on the case and the illustrations were very helpful in the process.  Thank you for all of your assistance."

—Attorney, Jim Miller, Dickie, McCamey & Chilcote, P.C., Pittsburgh, PA