Bowel Necrosis Leads to Death and $1.5 Million Settlement

2010 Medical Malpractice Trial Report

59-year-old woman dies from septic shock secondary to delay in diagnosis and treatment of ischemic colitis

On 12/7/04 at 2:00 p.m., the patient presented to the ER with complaints of abdominal pain that had progressively worsened over a week, epigastric pain, left shoulder and breast pain, dizziness, nausea, and diarrhea. Her vital signs on arrival were blood pressure 124/64, heart rate 117, temperature 98.7, respiratory rate 29, and room air oxygen saturation 97%. The ER doctor examined the patient and noted that her abdomen was soft with diffuse tenderness to palpation. At 3:35 p.m., the patient was medicated for pain with 4 mg of Morphine. The laboratory studies revealed an elevated white blood cell count of 16.2 (normal 4-11).

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At 3:55 p.m., the patient’s blood pressure was elevated to 189/76, and she complained of 7/10 pain. At 5:55 p.m., the patient was medicated with 4 mg of Morphine for 20/10 pain. Nursing noted that she was moaning in pain and sitting on the edge of the stretcher. At 6:45 p.m., the patient continued to complain of 20/10 pain. At 7:00 p.m., the patient was medicated with 4 mg of Morphine for her continued complaints of 20/10 pain with moaning. At 7:40 p.m., the patient underwent an abdominal CT scan which revealed diverticulosis as reported by the radiologist.

At 8:55 p.m., the patient complained of persistent severe lower abdominal pain 20/10 and that the Morphine didn’t help much. The patient continued to complain of abdominal pain and she was medicated with Tylenol at 10:40 p.m. The pain improved and she was discharged to home at 10:50 p.m. with instructions to return to the ER with worsening pain, fever, or other concerns, and to otherwise follow-up with her primary care physician the following day.

The next day the patient returned to the ER with complaints of severe persistent abdominal pain across the lower right and left quadrant which radiated up to the diaphragm. She reported that it was a sharp, cramping, 20/10 pain that increased with palpation and motion. Her vital signs were blood pressure 126/42, heart rate 115, temperature 97, respiratory rate 20, and room air oxygen saturation 100%. Laboratory studies were performed and revealed that she was suffering from septic shock. She underwent a repeat abdominal/pelvic CT scan that revealed new development of several areas of free air seen within the peritoneal cavity when compared with the previous study.

She was immediately taken to the OR where she was found to have gangrene of the small bowel, and perforation of the cecum with free stool in this area. 58 cms of small bowl was resected. She was transferred to the surgical ICU where she required aggressive fluid boluses and multiple pressors in order to maintain her blood pressure. She continued to be acidotic even after infusions of bicarbonate. Despite these interventions, she went into cardiac arrest and she died on 12/9/07 at 9:10 p.m. from septic shock secondary to ischemic colitis.

The plaintiff contended that the radiologist who reviewed the CT scan on 12/7/07 failed to identify and report findings of impaired blood flow on the abdominal and pelvic CT scan and failed to recommend an urgent surgical consultation. The radiologist contended that the CT did not show evidence of impaired blood flow, and that he complied with the standard of care in all aspects of his interpretation of the study.

The case settled following discovery for $1,500,000.

Lubin & Meyer attorneys represented the plaintiff in this bowel necrosis lawsuit.

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