Untimely Diagnosis of a Bowel Obstruction and Delay in Surgical Intervention Leads to 5-Year-Old Child’s Death

This case involves a 5-year-old female who presented to the ER with abdominal pain. She had a past medical history significant for developmental delay and required an intravenous total parenteral nutrition feeding tube placement (TPN) several months prior. The patient was admitted for observation, x-rays were ordered but the interpretation of imaging at this time was abdominal pain due to constipation and the patient was discharged. The following day the patient returned to the hospital with increasing pain and at this time abdominal imaging studies revealed a dilated intestine with possible perforation. The patient was brought into surgery and a volvulus was discovered to be the cause of the pain. According to the medical records, the patient experienced a prolonged lack of blood supply to the abdominal viscera and subsequently sustained a significant amount of bowel necrosis. The patient could not be weaned off the ventilator post operatively and the family decided to withdraw life support shortly thereafter.

Question(s) For Expert Witness

The issue is whether the CT scan would have revealed the volvulus immediately and would this have made a difference in the outcome of the surgery had it been performed sooner?

Expert Witness Response E-004694

I can say with a great deal of certainty that this patient would have benefited from a timely diagnosis and prompt institution of surgical intervention. In any field it is the physician's duty to rule out any life threatening causes of illness before adopting an observation approach and it seems more aggressive care was warranted here.