This case involves a post-operative 68 year old male who was admitted to the ER complaining of severe abdominal pain. He had undergone gastric bypass surgery a few weeks prior and 3 days after his readmission to the hospital he continued to experience abdominal pain, vomiting, and was unable to tolerate food. He was initially diagnosed with acid reflux and told to take Nexium, a heartburn medication. However, he came back two days later with progressive symptoms. Upon admission to the hospital the patient had a blood cell count of 18000 at which point a CT-abdomen was taken without contrast. The report indicated free air in the right upper quadrant with suspicion of a perforated viscus. A fistulous tract was also seen between the stomach and the right upper quadrant peritoneal cavity. The patient was left untreated for 3 days and on the fourth day his white blood count was 35000. The physician planned to do an upper GI series but the patient’s condition continued to deteriorate, he was intubated and later passed away the following day.
Question(s) For Expert Witness
- 1. Having recently undergone a gastric bypass surgery and presented with symptoms indicated above, should the doctor have ordered the full workup on the patient?
Expert Witness Response E-001161
This patient is high-risk due to many factors, including his age. Standard of care would have been deploy more aggressive care upon finding out that he had an elevated blood count and a potential injury to his stomach as a result of the operation. Surgery should have been performed within 24 hours of the diagnosis, at the latest. Unless there are clear indications, a delay in surgery is a deviation from standard of care.