A bowel perforation, or a nicked bowel, occurs when a hole is made in the bowel or anywhere in the gastrointestinal tract, which allows the contents of the bowel to flow into the abdominal cavity. The GI tract is a continuous tube that begins at the mouth, goes down your throat, through the stomach, small intestine, and large intestine, and into the bowel. A bowel perforation should be treated as a medical emergency because the bowel contents in the abdominal cavity can cause infection called peritonitis, which can lead to sepsis if untreated and can lead to death.
What causes bowel perforation?
There are many causes of bowel perforation such as certain diseases, trauma to the abdomen or a medical error during an abdominal surgery procedure. Some of the causes might include:
- Toxic megacolon
- Peptic ulcer disease
- Ulcerative colitis
- Crohn’s disease
- Fecal impaction
- Acute cholecystitis
- Surgical complications
Is a perforated bowel after abdominal surgery always medical negligence?
The short answer is, no. A bowel perforation is a known complication of abdominal surgical procedures. When a patient suffers a bowel perforation as a post-surgical complication, the question is not whether the bowel was nicked as a result of negligence; rather, the problem lies in whether the surgeon recognizes the injury during surgery or immediately following surgery and treats it appropriately. There are many cases in which it might be nearly impossible to perform certain procedures without nicking any part of the GI tract.
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What determines whether the injury was medical malpractice?
There are a few basic elements that a medical malpractice claim must meet before is can go forward including:
- The existence of a doctor-patient relationship
- The doctor’s actions did not conform to the accepted standard of practice (negligence)
- The doctor’s negligence was the direct cause of the injury
- The patient’s injury caused specific damages
In a medical malpractice claim, the injured patient, who is the plaintiff, must be able to prove that the doctor or other medical professional’s negligence caused their injury. Given that a bowel perforation itself is not always a medical error, the plaintiff would have to prove how the physician’s actions breached the standard of care by failure to recognize and treat the bowel perforation in a timely manner.
What are the symptoms of a perforated bowel?
The symptoms of a perforated bowel include:
- Severe abdominal pain
- Swollen, firm abdomen
- Nausea and vomiting
- Rapid heart beat
- Blood in the stool
How is a perforated bowel diagnosed and treated?
The manner in which a bowel perforation is diagnosed will depend on the case specific facts. Some perforations may be diagnosed immediately after surgery, while some may present later in time, in the form of a visit to the emergency department. A visit to the ER with severe abdominal pain shortly after surgery is an important clue for a GI perforation. An X-ray of the abdomen would show the air in the abdominal cavity and a CT scan may also be done to diagnose a nicked bowel, which would require surgery to repair the cut and clear the abdominal cavity of fecal matter, food particles and bile which may have leaked out through the opening. Antibiotics would be administered to treat and prevent infection.
Depending on the severity of the perforation, if the doctor is unable to repair it sufficiently, they may have to attach a colostomy, which is a pouch attached to the bowel outside of the body.
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