Patient Suffers Extensive Organ Damage from Undetected Bowel Perforation

This case involves a 32-year-old male patient with a past medical history of ischemic colitis. He presented to an urgent care facility with complaints of abdominal pain. The patient reported that the pain was associated with chills, dry heaves and radiated from his lower abdomen upwards. The patient described the pain as 10/10, and noted that he had not had a bowel movement for several days. Nevertheless, the patient was discharged by the physician with a diagnosis of constipation. The patient called the facility some time later to let them know that his pain had gotten worse, but he was told to wait until morning to see a doctor. Finally, the patient presented to the ER, at which point an exploratory laparotomy was performed and a perforation identified in his colon. The patient required a significant resection of his small and large intestines, and he must now wear a colostomy bag.

Question(s) For Expert Witness

1. Do you routinely treat patient's with bowel ischemia? If so, how often?

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

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.