This case involves a middle-aged patient who presented to an emergency room in California with complaints of gut pain, nausea, and vomiting. Despite her extreme pain, she was not taken for imaging studies for several hours, at which point X-rays indicated that there was an early partial bowel obstruction. The patient was taken back to the emergency room and had to wait in excruciating pain for several hours for additional CT scans. Additional CT scans showed a bowel obstruction, and what appeared to be a swirl pattern of the interior region suggesting a volvulus. The patient was finally taken into surgery several hours later, when surgeons found extensive areas of necrotic bowel. She died in the hospital several days later.
Question(s) For Expert Witness
- 1. Do you routinely work up patients who present with the complains listed above?
- 2. How quickly must an ER coordinate surgical intervention for a patient in this condition?
Expert Witness Response E-008259
I evaluate patients with severe abdominal pain all of the time, several times during my clinical shifts. Yes, I have had patients with intestinal ischemia from either a volvulus, such as the case with this patient, or from acute thrombosis (clot formation) or embolism (thrown clot to cause blockage). Emergent surgical intervention is required once this diagnosis has been made. I do not see any major issues with this case until the diagnosis of “bowel ischemia” is made, then more emergent care is required to treat this situation. I would not have allowed a surgeon to wait for this consult to occur.
Expert Witness Response E-007048
As a practicing emergency physician at a major academic medical center, I routinely care for patients presenting with the complaint of abdominal pain. I have cared for a patient with a similar presentation in the past. Indeed, if the diagnosis of volvulus is suspected by history, exam and labs, then immediate resuscitation and prompt surgical attention is warranted.