A general surgery expert witness advises on a case happened in Delaware involving a sixty-one year-old male patient with a past medical history of ischemic bowel disease. He presented to an urgent care facility at 1PM with complaints of severe abdominal pain and discomfort. The patient reported that the onset of the pain was about 2 hours earlier and was associated with chills, dry heaves and radiated from the suprapubic/bilateral lower quadrant. The patient described the pain as 10/10 and he had only 1 small bowel movement during the days leading up to this incident, which he described as extremely hard and solid. The patient was discharged by the physician with a diagnosis of constipation and was prescribed Colyte and instructed to take Vicodin for relief. Approximately 3 hours later, the patient presented for a 2nd visit to the urgent care facility where a similarly limited workup was ordered. The patient was discharged quickly and advised to get rest and take Vicodin for relief. Finally, approximately 4 hours later, the patient presented for a 3rd visit to the facility and was promptly referred for ER workup, at which point an exploratory laparotomy was performed. The patient required a significant resection of the sigmoid, descending, transverse, ascending and cecum portions of the colon. Approximately 50 percent of the distal small intestine was resected and the patient now requires a colostomy bag. The size of the hole identified in the patient’s sigmoid colon was approximately 2 inches in a linear basis and stool was exiting the colon into the peritoneal cavity at the time of the surgical procedure.