Anastomotic Leak and Death By Sepsis Following Gastric Bypass Surgery 

In this case, recently concluded in Kings County, a 44 year old man underwent Roux-En Y Gastric Bypass during which a Jackson Pratt drain was placed.  As per surgeon's post-surgery order, an Upper GI series was undertaken to rule out an anastomic leak.  The radiologist defendant properly observed an obstruction at the gastrojejunal junction but failed to diagnose the anastomotic leak which was demonstrated on overhead and floroscopic imaging.  The undiagnosed leak lead to gastric sepsis and death.

Gross Diagram of Surgery, "Before" and "After", set the anatomical foundation of the case for the jury and helped them focus on the site of the leak (and location of the obstruction), at the junction of the gastric pouch and Jejunum

During the surgery a Jackson Pratt Drain was placed at the site of the anastomosis in order not only to drain fluid from the surgical site, but as a means of monitoring for a leak 

This is the order written by the surgeon for a post-surgical Upper GI Series to rule out a leak

Here we see in side by side fashion, so that the jury could be oriented to not only the key surgical site, the source of the leak, but also how the Jackson Pratt drain was placed in order to certainly catch a leak from the anastomosis.  The black overlay on the right side of the side by side shows the drain's placement with reference to the overhead of the surgical site on the right.  Note that the proximate Jejunum on the overhead film is absent because there was also an obstruction and the site of the anastomosis

Here was the clear cut evidence of the leak.  To the left we see the drain portion of the JP drain but not the tube portion of it.  The tube portion is not demonstrated because the contrast of the study had not yet reached beyond the radio-opaque of the drain.  To the right we see later in the study the presence of contrast not only in the drain portion of the JP drain, but also now clearly extending into the tube and even to the portion of the tube which is out of the body

Here was see the pre-contrast overhead scout film (left) and the post-contrast overhead (right).  Note how there is no contrast in the JP drain's tube portion-it showing absent in the left image while in the right image it is well demonstrated as it contains contrast

This is the conclusion page of the autopsy report which clearly establishes the cause of death