Child Dies From Bowel Necrosis After Failure to Diagnose Volvulus

Case Overview

This case involves an eight-year-old female patient who presented to the ER with a two-day history of severe abdominal pain. She had a past medical history significant for developmental delay and difficulties feeding. The patient underwent surgery to place a feeding tube several months prior to presentation. The patient was examined in the ER and admitted for observation. Abdominal x-rays were ordered but the interpretation of imaging at this time was abdominal pain due to constipation and the patient was discharged shortly thereafter. No CT scan was performed. The following day the patient returned to the hospital with increasing pain and it was at this time that a pediatric emergency medicine physician ordered a CT scan. The repeat abdominal imaging studies revealed a dilated intestine with possible perforation. The patient was brought into surgery urgently and a volvulus was discovered to be the cause of the patient’s 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 by the time she finally went to surgery. The patient could not be weaned off of the ventilator post-operatively and the family decided to withdraw life support shortly thereafter.