Delayed Diagnosis of Small Intestine Perforation Causes Sepsis

This case involves a 67-year-old female patient, who previously had an esophagectomy, and then developed complications after undergoing surgery to her small intestine. The patient was losing a significant amount of weight over a 6-month period, so an attempt to re-establish the feeding tubes was made. Her caregivers tried to insert the feeding tube three times before being successful. However, 2 days later she was taken to the emergency room for severe abdominal pain and it was revealed that the patient had suffered a perforation of the small intestine. There was a delay in diagnosing the perforation during which she developed sepsis. Blood clotting from sepsis grew so severe that she is no longer able to move her left leg.

Question(s) For Expert Witness

1. How frequently do you treat patients with bowel perforation?

2. What is the standard work up for a patient with suspected perforation of the bowel?

3. Can a delay in diagnosis lead to worse outcomes for the patient?

Expert Witness Response E-004038

Bowel perforation is a rare complication in Interventional Radiology and I have been fortunate enough to only see it once in one of my patients. The standard workup for a patient with suspected perforation of the bowel is physical exam and abdominal radiograph. A delay in diagnosis can definitely lead to a worse outcome for the patient.