General Surgery Expert Witness Advises on Undiagnosed Small Bowel Obstruction Which Went Untreated

A general surgery expert witness advises on a case involving an 80-year-old female who required significant abdominal surgery. Prior to discharge, the patient complained of severe nausea and limited appetite (per her medical records). She was sent for an x-ray, which indicated a small bowel obstruction. Sadly, no action was taken – and the surgeon treating her claims that he never received a copy of the x-ray / report and would have taken action if he had. The patient died three days post discharge because of the undiagnosed/untreated obstruction.

Question(s) For Expert Witness

1. Based on the information above, would you have rendered care to this patient prior to discharge?

2. Have you ever had a patient develop the complication noted in this case overview?

3. Have you ever served as an expert witness on a similar matter?

Expert Witness Response

Small bowel obstructions are significant consequences from abdominal surgery and need to be addressed carefully to minimize the risk of further complications to the patient. Not only does the obstruction need to be treated, but the cause for the obstruction needs to be evaluated as well. Some common causes for such obstruction are inadvertent bowel injury, abdominal abscesses, or other known complications from extensive abdominal surgery. Furthermore, the patient's age makes her a high-risk candidate for such potential complications, which makes the occurrence of obstruction a potentially ominous sign. Obstruction is a common complication from major surgery, so I have taken care of patients with this condition. However, none of my patients died because of carelessness or misdiagnosis of obstruction.

This sounds like failure to diagnose and treat as well as premature discharge. I certainly believe that had the care rendered been different, this patient would have had a better outcome. I have reviewed numerous cases similar to this one in the past.