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.
www.illustratedverdict.com

 

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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
Bowel Injury During Ovarian Cyst Removal

A 27-year-old woman underwent a laparoscopic surgery to have a complex ovarian cyst removed after suffering from “significant pelvic pain” for two weeks. Her doctor began the surgery as a laparoscopic procedure, but before completing the operation observed three small lacerations or tears on the outer surface of the bowel. He requested a consultation from a general surgeon regarding the appropriate way to repair these injuries. The general surgeon determined that the bowel injuries were not full thickness wounds and only involved the serosal (outer) layer of bowel tissue. He recommended that the operation be converted to an open procedure so that he could suture the serosal lacerations. Both doctors testified that the serosal injuries occurred as a result of taking down adhesions which had formed as a result of prior abdominal surgeries.

 

PLAINTIFF'S CLAIM:

The plaintiff claims that the bowel wall was fully perforated during the procedure, resulting in bowel leakage.

 

DEFENSE'S ARGUMENT:

The defense maintains that the leaks were the result of an injury to the serosa (the outermost layer of the bowel) caused by dissection of adhesions, not by a direct puncture of the bowel.




VISUAL STRATEGY:

Collaborating with the defense attorney and experts, IV created a visual strategy that helped explain that the defendant’s actions were within the standard of care.

 

We began with illustrations that demonstrate the normal anatomy of the female abdomen and pelvis, abdomen and pelvis including the relationship to the bowel, and a sagittal view of the abdomen and pelvis.

 

A fourth diagram was created to show a superior view of a normal female pelvis.

 

Diagrams were created to demonstrate how in a laparoscopic procedure, the abdomen is inflated with a veress needle to avoid hitting abdominal organs during the placement of the laparoscope and instrument trocars.

 

A sixth diagram was used to show an anterior view of the abdomen with the camera and trocars inserted for the laparoscopic procedure.

 

We then created illustrations that depict what a surgeon would expect to see in a laparoscopic procedure of a female pelvis with normal anatomy as well as the extensive abdominal adhesions the surgeon encountered in this case.

 

Diagrams were also developed to demonstrate the surgeon’s views as they converted to an open procedure revealing extensive adhesions, as well as comparison of a normal anatomy of the female pelvis.

 

Finally, an illustration highlighting the layers of the bowel wall was used to show that with the plaintiff’s bowel leak presenting days later, it was more likely a serosal (outer layer) injury that moved inward over time, rather than an actual full thickness injury that would have presented sooner after the procedure.

 

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

  • The defendant made the correct decision in switching from a laparoscopic procedure based on the injuries to the bowel and the extensive adhesions.
  • The plaintiff’s bowel leaks were not the direct result of puncture from the instruments in the laparoscopic or open procedures. The extensive adhesions were the more likely culprit to have caused small serosal tears that eventually opened up into full thickness tears.

 

RESULT:
The jury found in favor of the defense. 

“We got a defense verdict in only 16 minutes. I think the exhibits were helpful in making the jury understand the surgery and medical issues.

- Claims Specialist Sarah Fulkerson, Healthcare Services Group,
Jefferson City, MO