Delayed Diagnosis of Mesenteric Ischemia

The Weton Case

This death case involved a 44 year-old single parent who became critically ill 10 days following an apparently successful laparoscopic gallbladder operation. The patient was admitted through the Hospital Emergency Room with symptoms of severe abdominal pain, nausea, vomiting, and fever.

The surgeons who performed the gallbladder procedure ordered abdominal x-rays and CT scans over the next 6 days as their patient’s stomach became distended, all of her symptoms worsened and she became lethargic and septic. A resident finally ordered the appropriate radiology study on the night of the 5th day which established likely mesenteric ischemia. The surgeons further delayed exploratory surgery until they received the results of repeat studies the next day.

Exploratory surgery on the 6th day found a gangrenous bowel and the patient’s entire intestines were removed in two operations.

The patient died two weeks later from infection and multiple system failure. Plaintiff’s experts were unable to establish whether or not the intestine or its blood supply had been injured during the original gallbladder surgery. Suit was filed against the surgeons for failing to order a 3-way abdominal series and to follow-up on free fluid seen on abdominal and pelvic x-rays. Suit was filed against the radiologist for failing to follow-up on signs of necrotic bowel/mesenteric ischemia seen but not reported on the scout films from the abdominal CT. Plaintiff’s expert would have testified that the patient would have had a greater chance of surviving the insult to her bowel had the condition been diagnosed and exploratory surgery performed several days earlier than it was. The radiologist defendant settled before trial.