Delayed Diagnosis of Small Bowel Obstruction Causes Ischemic Bowel and Sepsis

Case Overview

This case involves a 59-year-old male patient who presented to the emergency room with severe abdominal pain. A CT-abdomen was performed and the report showed a distal small bowel obstruction. The patient was treated with IV hydration, Zofran, and Dilaudid but no plans were made for surgical intervention. The patient’s medical status deteriorated severely over the course of one week and he went into cardiac arrest and sustained aspiration pneumonia as a result of CPR and intubation. The patient died less than 7 days after his initial admission with autopsy reports stating the cause of death to be sepsis secondary to significant ischemic bowel disease.

Questions to the General Surgery expert and their responses

What is the appropriate way to treat a patient who presents to the ER with a distal small bowel obstruction?

There is a process that an astute surgeon will go through to figure out the severity of the situation at hand when a possible small bowel obstruction is on the differential.

Could this situation and the patient's deterioration have been avoided?

If one goes through all of the steps and monitors the patient according to accepted standards, this type of problem is hard to miss.

About the expert

This actively practicing, board certified general surgeon has remained in active practice for over 25 years. During this time, he has been appointed as fellow for several prestigious surgical professional societies, and has obtained high ranking clinical and administrative positions at several medical universities. Finally, he is also extensively published in his field.