![]() ![]() The defense in this case focused on the rarity of this condition, along with the limited time window to successfully save FR’s life. Failure to identify and treat small bowel volvulus in a timely manner can lead to catastrophic results. Plain radiography and CT of the abdomen are the most practical and useful diagnostic modalities.Īll patients suspected of having complicated bowel obstruction (complete obstruction, closed-loop obstruction, bowel ischemia, necrosis, or perforation) based upon clinical and radiologic examination should be taken to the operating room for abdominal exploration. In contrast, small bowel volvulus is relatively rare. When it occurs in adults, volvulus usually affects the sigmoid colon or the cecum. It results from abnormal twisting of a loop of bowel around the axis of its own mesentery and often results in ischemia or even infarction. Volvulus is a special form of mechanical intestinal obstruction. The complaint further alleged that had they done so, the small bowel volvulus would have been discovered and successfully treated, preventing FR’s demise. Hospitalist both failed to appropriately image FR’s abdomen with either a plain abdominal radiograph and/or CT scan of the abdomen. The complaint alleged that the ED physician and Dr. She followed up with an attorney almost immediately, who had the case reviewed and subsequently filed a lawsuit. ![]() She felt that none of the medical providers took her mother’s complaints seriously because FR had a history of "anxiety." The daughter was particularly angry over the fact that the ED physician actually wanted to discharge FR in the presence of a lethal condition. The daughter was shocked and upset over the sudden death of her mother. FR was last seen by the nurses an hour earlier and had been documented as "sleeping." An autopsy was performed and discovered small bowel necrosis consistent with a small bowel volvulus. Resuscitation efforts confirmed a profound acidemia (pH 6.55), and FR did not survive. The plan included a routine GI consult, a routine plain film of the abdomen to look for evidence of gastric distention, keeping FR nothing per os (NPO), and continuing intravenous fluids and analgesia.Īt 8:30 a.m., FR was found unresponsive and a Code Blue was called. Hospitalist was acute postprandial abdominal pain of unclear etiology. FR’s abdomen was noted to be "reasonably soft" with hypoactive bowel sounds. Hospitalist documented that FR had a history of hypertension, hyperlipidemia, anxiety, and depression, along with a gastric lap-band procedure 2 years ago for morbid obesity. Hospitalist saw FR on the medical floor, by which time the daughter had left the hospital for home.įR was lethargic from several doses of hydromorphone, but she was still complaining of severe abdominal pain. Hospitalist to admit FR for uncontrolled abdominal pain. The daughter, who had been with her mother all evening, became very upset and demanded that the patient be admitted because something was obviously wrong with her mother. The CXR, right upper quadrant ultrasound, Chem-12, lipase, and CBC all returned within normal limits.Īt this point, the ED physician recommended discharge home with outpatient follow-up. About 1 hour later, FR reported minimal improvement in her symptoms. In the meantime, FR received a "GI cocktail" (Mylanta, viscous lidocaine, and Donnatal) by mouth, along with intravenous morphine and Zofran. The initial impression by the ED physician was biliary colic, and he also ordered a right upper quadrant ultrasound. Abdominal pain, nausea and emesis are all symptoms to watch. ![]()
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