Doctors Fail to Identify Hole in Large Intestine

This case takes place in Ohio and involves a male patient with a past medical history of ischemic colitis. She presented to the emergency room with complaints of severe abdominal pain and discomfort. The patient reported that the onset of the pain was was associated with chills, dry heaves and radiated from the lower right side of his stomach. The patient described the pain as severe and claimed he had not had a bowel movement for several days. The patient was discharged by the physician with a diagnosis of constipation and was instructed to take painkillers for relief. Several hours later, the patient presented for a 2nd visit to the emergency room where a similarly limited workup was ordered. The patient was discharged quickly and advised to rest and take painkillers for relief. The patient presented for a 3rd visit to the facility and was promptly referred for a more extensive workup, at which point an exploratory laparotomy was performed. The patient required a significant resection of his colon. Additionally, a large amount of the small intestine was resected and the patient now requires a colostomy bag. The size of the hole identified in the patient’s colon was significant, and stool was exiting the colon into the peritoneal cavity at the time of the surgical procedure.

Question(s) For Expert Witness

1. Do you routinely treat patients with bowel ischemia? If so, how often?

2. Can a delay in diagnosis affect the patient's prognosis? Please explain.

3. Have you ever served as an expert witness on a case similar to the one described above?

Expert Witness Response E-006364

This patient should have had a CT scan performed at the first visit to the urgent care. Depending on the findings, lab work and physical exam should probably have been emergently evaluated by a surgeon. Bowel ischemia is an uncommon problem. As a surgeon I see 2-3 cases a year. It is something with which I am highly knowledgeable and qualified to treat. It is possible that a delay in diagnosis can worsen the the prognosis. The severity of the post-operative complications is often related to the duration of the delay. Much depends on the etiology of the ischemia. If it was a large vessel occlusion by a clot, then a vascular procedure may have been able to be performed to restore flow to the bowel. Often, however, once the bowel is necrotic it needs to be resected and a colostomy is often necessary. I am glad to assist with this case and discuss further.