When a person is admitted to the hospital with a bowel obstruction, it’s considered a potential medical emergency. Add new (acute) abdominal pain and it becomes a potential surgical emergency.
Symptoms & Diagnosis
When working up a patient for potential bowel obstruction, providers consider the textbook symptoms of abdominal pain and swelling (distention), vomiting, and the inability to pass flatus. Some patients describe it as feeling “backed up.”
One of the first tasks for physicians is to determine what’s causing the obstruction. There are a lot of conditions that should be in a differential diagnosis, each with a differing degree of danger to the patient. The physician will do a thorough physical exam, and often order diagnostic radiology scans, to rule in or out the following conditions that can cause a bowel obstruction:
• Impacted stool (fecal mater stuck in the intestine)
• Volvulus (strangulation or a twisted intestine)—this is a surgical emergency because it can cut off blood flow and kill the intestines
• Foreign body stuck in the bowel
• Scar tissue or adhesions from a prior surgery
• Infection (gastroenteritis)
• Metabolic imbalance
• Ileus (the bowels aren’t working, with no structural cause)
• Hernia
• Tumor blocking or obstructing the intestines
Interestingly, the most common cause of an obstruction of the small intestine is scar tissue or adhesions from a previous surgery.
In my experience, some physicians miss the proper diagnosis by relying on simple abdominal x-rays, as opposed to advanced imaging. Studies show that x-rays miss a bowel obstruction about one-fourth of the time. Radiologists consider an abdominal CT scan the test of choice. Thus, many experts believe that a doctor shouldn’t stop the workup with a negative x-ray, but should order a CT scan in the interest of patient safety.
Treatment and Fluids
Once the physician determines the cause of the bowel obstruction, she can move on to deciding on the treatment. One of the things that I learned from a recent case is that regardless of the cause of the obstruction, doctors need to give careful attention to the patient’s fluids.
The intestines play a significant role in the absorption of nutrients and electrolytes. That’s why anyone suffering from a bowel obstruction needs to be evaluated for lost fluids and electrolytes, and likely should be started on intravenous (IV) fluid and electrolyte supplementation. This is called fluid resuscitation.
Fluid resuscitation plays an important role even when a patient requires surgery to address a bowel obstruction. I’m working on a case now where a patient had an obstructive tumor in her colon. She didn’t know anything was wrong until she went to an emergency room and had a CT scan because of abdominal pain. After a colonoscopy, she was diagnosed with colon cancer and referred for surgery.
She was admitted to the hospital and waited a few days for surgery. During that time, she was not fluid resuscitated. On the day of surgery, an anesthesiologist met with her for a pre-anesthesia evaluation, a consultation done to make sure the patient can tolerate surgery safely. The anesthesiologist should have identified the patient’s fluid crisis, meaning that she was under-resuscitated. Unfortunately, this physician blew right past it.
Even worse, during the surgery to remove the colon tumor, the patient started having breathing and heart problems. In fact, the surgery had to be paused because she went into respiratory and cardiac distress. Her condition became so grave that they could not complete the operation.
According to the anesthesiology expert that Painter Law Firm hired to review the case, if the anesthesiologist had taken time to address this patient’s fluid status before surgery, it would’ve been easy to avoid this complication and the surgeons could have completed the procedures. Instead, she went into hypovolemic (fluid loss) shock and ultimately died as a result of these avoidable complications.
If you or someone you care for has been seriously injured because of medical, surgical, or anesthesia care, then you should immediately contact an experienced top-rated Houston, Texas medical malpractice attorney for help in evaluating your potential case.
