Delayed Diagnosis of Small Bowel Obstruction Causes Ischemic Bowel and Sepsis

    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.

    Question(s) For Expert Witness

    • What is the appropriate way to treat a patient who presents to the ER with a distal small bowel obstruction?
    • Could this situation and the patient's deterioration have been avoided?

    Expert Witness Response E-005325

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

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