This case takes place in New York and involves a male patient with a past medical history of ischemic colitis. He presented to the ER with complaints of severe abdominal pain and discomfort. The patient reported that the pain had begun several hours earlier and was associated with chills and dry heaves. Despite his pain, the patient was forced to wait for several hours before being seen by a doctor, who discharged him with a diagnosis of constipation. One day later, the patient presented to the emergency room in a different hospital complaining of extreme abdominal pain, at which point exploratory surgery was performed. The operating surgeon noted the presence of a large perforation in the patient’s bowel, which required a significant resection of multiple portions of the colon.
Question(s) For Expert Witness
- 1. Do you routinely perform the surgical procedures described above?
- 2. Could earlier intervention have made a difference to the outcome for this patient?
- 3. Have you ever served as an expert witness on a case similar to the one described above?
Expert Witness Response E-008057
I routinely perform this surgical procedure. In this case, the patient needed a more thorough evaluation by the clinician, including CT scan and blood work. Undoubtedly, the workup would have shown that he was septic and required surgery. The diagnosis of “constipation” is one of exclusion, only to be made after other diagnoses of ischemia, colitis, diverticulitis, or intra-abdominal sepsis have been ruled out. It sounds like he was inappropriately evaluated, and a timely diagnosis may have saved him from an extensive operation.
Expert Witness Response E-001161
I do see the ischemic colitis consults from time to time. I do perform colon resections as well, mostly for diverticulitis and its associated complications. Most of the elective colon cases (i.e. cancers) are handled by the colorectal surgeons on staff. In addition, I see a fair number of mesenteric (or small bowel) ischemia consults. As for the case above, it is definitely odd how a patient could present to an urgent care facility with acute abdominal pain and not have any imaging. Looks like he had a pretty extensive resection of both his colon and small bowel. In regards to acute ischemia, timing is everything. The goal is to reverse the ischemia within several hours of onset, otherwise the bowel will most likely not be salvageable (it will be necrotic and need to be resected). So earlier intervention in this patient would have likely led to less bowel being resected and possibly less contamination from stool spillage.