The plaintiff's decedent, age seventy-seven, went to an emergency room in July 2004 with complaints of abdominal pain. The radiologist performed and interpreted a noncontrast CT scan of the abdomen and pelvis. The radiologist noted copious stool and constipation producing a degree of obstruction. The radiologist also noted that the descending colon was dilated to thirteen centimeters and that the stomach was overly distended. The results were communicated to the nurse practitioner in the emergency room. The nurse practitioner diagnosed constipation.

Over the next eight hours the decedent was given low doses of narcotic medication and an enema. He was discharged from the emergency room the following morning still complaining of pain. That afternoon the decedent returned to the emergency room with complaints of severe abdominal pain, blurred vision, weakness and dizziness. Plain abdominal imaging revealed a hugely dilated small intestine. A radiologist reported that gastric and/or colonic volvulus bowel obstruction could not be ruled out.

A surgical consult was obtained and an exploratory laparotomy was performed. During surgery the surgeon found the decedent’s entire ileum to be necrotic with patchy necrosis of the ascending and transverse colon. The entire ileum and colon with patchy necrosis was resected and an anastomosis was done from the jejunum to the rectosigmoid colon. During the postoperative period the decedent became extremely hypotensive due to sepsis. An esophagogastroduodenoscopy study confirmed a bleeding gastric ulcer in the antrum. Despite embolization of the left gastric artery the man died. An autopsy found the cause of death to be exsanguination of a bleeding ulcer post-exploratory laparotomy.

The plaintiffs claimed that the radiologist was negligent in failing to describe the stomach from the CT scan as being twice the normal size. The plaintiffs claimed that the nurse practitioner was negligent in discharging the decedent without requesting a surgical consult and/or ordering further imaging studies after administration of the enema failed to relieve the abdominal pain. The plaintiffs argued that the delay in diagnosis of the volvulus caused the necrosis and that an earlier diagnosis should have been made. The plaintiffs maintained that the gastric ulcer was due to the sepsis and surgical stress from the extensive laparotomy and resection of the necrotic bowel.

The radiologist claimed that her interpretation of the CT scan was proper and the nurse practitioner claimed that the decedent improved after the enema. The defendants argued that the volvulus was evolving at the time they saw him and that the CT scan was not suspicious for volvulus. The defendants maintained that even if volvulus had been diagnosed at that time an exploratory laparotomy would have been required. The defendants further argued that the gastric ulcer preexisted the hospital visit and that any surgical procedure would have exacerbated the ulcer.

According to a published account a defense verdict was returned.

With permission from Medical Malpractice Verdicts, Settlements & Experts; Lewis Laska, Editor, 901 Church St., Nashville, TN 37203-3411, 1-800-298-6288.