Delay of Cardiovascular Surgery Causes Multiple Amputations

This case involves an elderly woman with a past medical history of diabetes and on peritoneal dialysis for end stage renal disease. She presented to a local hospital with complaints of lower abdominal pain. She was not seen immediately, but was given painkillers while she waited. A CT scan was eventually ordered and revealed an abdominal aortic aneurysms and she was transferred to a nearby hospital that was better equipped for the surgery. However, once at the new hospital, the cardiovascular surgeon determined the patient did not meet the criteria for emergent surgery since she was in stable condition. She subsequently continued to experience increased abdominal pain and the aneurysm was found to already be leaking by the time surgery was performed and she had to undergo multiple amputation in her lower limbs.

Question(s) For Expert Witness

1. Do you routinely treat patients like the one described in this case?

2. Have you lectured/published on the management of such patients?

Expert Witness Response E-001075

Having both lectured and published on emergent abdominal aortic aneurysms it is clear the immediate course of action should have been to determine if the patient had an unstable or even ruptured aneurysm. With ruptures, this can be a free rupture into the peritoneal cavity or a contained rupture into the retroperitoneal space, regardless it is vital to respond quickly.