General Surgery Expert Evaluates Delayed Treatment of Small Bowel Obstruction

Joseph O'Neill

Written by
— Updated on December 22, 2017

Gastritis Expert WitnessThis case involves a female patient who presented to her primary care physician with complaints of abdominal pain, nausea, heartburn, and vomiting. During the visit, the patient noted that the symptoms had been present for over a month, but that they had gotten much worse over the course of the preceding week. The physician ordered a full upper GI series and prescribed heartburn medication. During a subsequent visit to the same doctor’s office for an unrelated issue, there was no follow up on the earlier gastrointestinal concerns. Over the course of several months, the patient presented to a number of other physicians for various concerns, none of who followed up on her recurrent intestinal symptoms. Eventually, the patient presented to the emergency room for severe gastrointestinal symptoms. After undergoing a series of testing that indicated the formation of a bowel obstruction, the patient was admitted to the hospital. Her condition continued to deteriorate over the next few hours, and she was eventually taken into surgery. During surgery, it was discovered that a significant portion of the patient’s bowel was necrotic due to a lack of blood flow caused by the bowel obstruction, which was related to an undiagnosed malformation of her digestive organs. It was alleged that more thorough workup by her treating physicians prior to her ER visit could have identified the issue before it led to bowel necrosis.

Question(s) For Expert Witness

  • 1. Do you routinely treat patients like the one described above?
  • 2. Do you have familiarity with the subject matter described above?

Expert Witness Response E-035901

I treat patients like the one in this case, both as a bariatric surgeon and also as an on call general surgeon dealing with emergency room surgical problems over the past 16 years. I am involved in a study of small bowel obstructions in bariatric surgery patients. One paper on this study was presented as a paper at the Annual Meeting of the American Society for Metabolic and Bariatric Surgery in 2014. This is an ongoing study involving our 16 years of experience at our program and additional papers are expected to come out of this study. In presence of mal-rotated gut with abdominal pain the patient needed a surgical exploratory laparotomy with lysis of adhesions and re-positioning of the mal-rotated gut. When this patient reached the ED triage, she already had mental status changes (agitation, verbally aggressive). Mental status changes associated with abdominal pain are an indication of a serious intra-abdominal problem and should have been detected by the ED physician and the surgeons. I’ve never had a patient develop this outcome, because similarly afflicted patients under my care were investigated and diagnosed promptly and the surgical treatment was associated with minimal morbidity.

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