Nursing Home Patient Dies From Undiagnosed Bowel Ischemia

This case involves an eighty-two-year-old woman who presented to the emergency department with intense abdominal pain. The patient lived in a nursing home, and many of the other residents had recently been hospitalized for gastrointestinal illnesses due to a viral cause. The head nurse on her floor assumed that this patient was infected with the same stomach virus and delayed reporting the patient’s complaints to the geriatrician on call. Further imaging in the ER determined that the patient did not have an infectious illness, but instead suffered from mesenteric ischemia. She was rushed into surgery, but the procedure resulted in significant bowel damage and the patient died shortly after her admission.

Question(s) For Expert Witness

  • 1. How important was it for the nursing home staff to get this patient to a hospital?

Expert Witness Response E-000736

Mortality rates range from 60-100%, depending on the source of obstruction. Predictors of mortality included older age, bandemia, hepatic and renal impairment, metabolic derangement, hypoxia, and sepsis. With an aggressive diagnostic and therapeutic approach, mortality can be reduced but this was not case for this patient due to assumptions made by the nursing home staff. It is essential to act early on clinical suspicion and not to wait for the development of hard evidence.


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