Bowel Perforation Causes Multiple Organ Failure and Death

This gastrointestinal case involves a middle-aged male who had undergone outpatient surgery to repair a knee injury. After the surgery, doctors discharged the patient with medication for pain. For several days after the surgery, the patient was unable to move his bowels. The patient also had significant abdominal pain, bloating, nausea, and lethargy. He was taken to the ER and admitted to the hospital. Doctors gave him stool softeners; however, he remained in significant pain. He did not receive a CT or any other abdominal imaging studies, nor did the ER doctor call in a surgeon when the patient initially presented to the hospital.

The patient spent several days in agonizing pain. So, the doctors eventually gave him a CT scan and diagnosed him with a perforated bowel. Doctors called for an urgent surgical consultation, and the patient underwent emergency surgery to repair the perforation. As a result of the delay in detecting his bowel injuries, the patient suffered from myriad complications, including trouble breathing and multiple organ failure. Doctors performed a series of additional surgeries in an attempt to stabilize the patient’s condition, including abdominal wash outs and drainage installation. Doctors also removed a significant length of the patient’s intestines. Despite these efforts, the patient developed sepsis and eventually died in the hospital.

Question(s) For Expert Witness

When a patient presents to the hospital with these symptoms, when should further diagnostic testing be ordered to rule out a bowel perforation?

Expert Witness Response E-005405

On presentation to the emergency room, the patient's symptoms were severe enough that he was admitted to the hospital, where he experienced no improvement in pain after stool softener. If the patient's pain on presentation was that severe, it would indicate a more serious underlying issue than standard constipation.

In this situation, the standard of care in the emergency department would have been to obtain a CT scan of the abdomen to determine the etiology of the pain. Even if a surgeon was consulted immediately, he or she would still have required a CT scan to asses what the underlying issue could have been.

What's more surprising here is that the patient continued to languish in the hospital for some days before additional diagnostic studies were performed. His delayed evaluation and surgery for this perforation undoubtedly contributed to his multiple severe complications and, ultimately, death. As this case demonstrates, bowel perforations are a serious medical situation, and are potentially fatal unless emergency surgery is performed.