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特集：医療英語 > Case 5: Bowel Obstruction - 腸閉塞症 -
A 50-year-old male who had undergone gastric bypass surgery one year previously visited the emergency room complaining of severe abdominal pain. The patient described his pain as localized to the lower abdomen and gave it a10 on a scale of 1-10 during an exam performed by the Emergency Department physician in the early afternoon. The patient's white blood cell count and temperature were normal.
A few hours later, the physician noted that the abdomen was distended, rebound positive and very tender to the touch. A CT abdominal scan was consistent with a partial small bowel obstruction. The attending physician was informed of the results of the CT scan and the patient was admitted.
Surgery was scheduled for the next morning at 8:00 a.m. The patient's pain continued without relief and morphine was administered throughout the night. By 6:00 a.m. the patient developed a fever and continued to complain of severe pain. During the surgery, the attending surgeon found obstruction of the proximal ileum with an area of necrosis requiring that a large segment around the site of obstruction be removed. The patient recovered without incident.
The patient filed a claim against the Emergency Department doctor, the attending physician and the hospital, alleging that they failed to treat his obstruction in a timely manner causing undue pain and suffering as well as the resection of a large segment of his small intestine, all of which could have been prevented.
The physicians should have taken into account the patient's medical history, including his gastric bypass surgery since adhesions can cause bowel obstruction. The fact that the patient's abdominal pain did not improve was a clear sign that urgent surgical care should have been provided. The necrosis in the small intestine could most likely have been prevented by early surgical intervention.
- Please summarize this case. What is the main point of the article?
- Was the patient's initial work-up complete?
- What additional steps should have been taken after the CT scan?
- Was the patient's surgery performed in a timely manner?
- Were the Emergency Department physician, and attending physician and hospital negligent? Why or why not?