Posted by Shiela Mauldin on 7/26/06

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I realize this is very long, but, I feel there was a delay
in diagnosis on the part of a gastroenterologist
ultimately leading to my husband's death.

My husband, Jack became ill in April 2000. He was
experiencing stomach cramps. From that time on, until
June 8, he was experiencing diarrhea, some cramping,
nausea off and on and occasionally night sweats. He felt
it was not painful or aggravating enough for him to
persue.

On June 8 Jack went to the ER with severe stomach
cramping, dehydration, nausea and diarrhea. Several blood
tests were done and x-rays. Prescriptions were Flagyl and
Robinal.

June 19, saw a provider at our family practitioner
clinic...same sysmptoms: nausea, diarrhea and stomach
cramping. However, he had began experiencing escessive
gas (both burping and flatuance) He was given samples of
AcipHex and prescribed Phenergan.

The week of July 6, Jack saw a gastrointerologist and was
scheduled for a colonoscopy. By this time, it was very
noticeable that he was losing weight and he had come from
a very active person to fairly sedentary.

July 13, colonscopy was performed. Nothing showed up
visually, however biopsies were taken and cultured. C.
Difficile showed positive. He was treated with Flagyl and
seemed to get better for a few weeks.

Around August 9, the nausea and mild abdominal cramping
returned and increasingly grew. Another appointment was
made with the gastrointerologist.

August 23, Jack saw the gastrointerologist, no tests were
taken, but the docgtor felt that the C. Difficile had
returned and prescribed a higher dosage of Flagyl.

August 25 - Jack went to the ER as the stomach cramping
had reached an intolerable level. Several x-rays and a Ct
were taken and it was determined there was either a
blockage or a mass in the small intestine. White blood
count is 17.2 at this time (I did not keep up with it
until this time. Exploratory Laparascopic surgery
scheduled for the next morning.

August 26 - Exploratory Laparascopic surgery perfomed by a
surgeon. No blockage or mass. The small intestine and
the lymph nodes were slightly enlarged. The
gastroenterologist stated the intestine may be sluggish
and if so, it will appear as a blockage on xray and Ct
scan. Jack weighed 203 on this date, he had lost 27
pounds since April 17. Meds: Flagyl, Demerol and
Phenergan with no relief.

August 28, morning doing well, but by midday, he was
projectile vomiting. Pain med changed from Demerol to
Morphine to help with the nausea. Meds: Flagyl,
Morphine, Phenergan, and Protonix.

August 29 - a gastric tube is placed to pull fluids fronm
Jack's stomach. Immediate relief is felt from teh
nausea. Midday there is bloody stool. Pressure socks are
applied in the PM. Weight 197.

August 30 - EGD and Colonscopy performed by
gastroenterologist. Ulcers are present in the stomach,
upper and lower small bowel and some ulcers in the colon
(they were not present in the previous colonoscopy). No
indication of Chrons, cancer or Sprue. Possible extreme
case of Salmonella. Meds: Flagyl, Protonix, Phenergan
and Vancomycin. White blood count is 19.

August 31-Sept 3 - steady improvement. Diarrhea is
slowing. Nausea subsiding and able to tolerate a regular
diet. He felt weka, but up and walking around. Home from
the hospital. Meds: Protonix, Cefzil, Phenergan and
Flagyl.

September 5 - welling well enough to ride to our hunting
club and visit. Short visit, he was extrememly tired.

September 6 - Cramping, nausea, diarrhea return. jack
virtually stops eating.

Sept 7 - surgeon removes staples, saw gastroenterologist
and he stated he was puzzled and was not quite sure what
was going on. Meds: Protonix and Phenergan.

Sept 10 - naw family practitioner, nausea and cramping are
becoming worse. a referral to another
gastroenterologist . Weight is 183 on this date. Whtie
blook count is 17. Meds: continue the Protonix and
Phenergan.

Setp 13 - saw new gastroenterologist and he thinks the
diagnosis is still the original problem with the c.
difficile. Meds: Vancomycin, Protonix, Phenergan, and
Dicyclomine. Use Maalox on a prn basis. Spoke to family
practitioner and he said to let him know in 2 days if Jack
not doing better.

Sept 15 - Jack not any better. Family practitioner
admitted Jack to the hospital. Ordered a central line
placement. Admitting meds: Vancomycin, Phenergan,
Solumedrol and Tylenol. Jack's admitting weight is 173
lbs.
THE PREVIOUS INFORMATION I HAD KEPT UP WITH DURING THE
ILLNESS. THE FOLLOWING IS FROM MEMORY AS I DID NOT
DOCUMENT ANYTHING ELSE.

Sometime during one of the previous hospital stays, the
gastroenterolgist stated it could be a vascular problem,
but Jack did not have any of the precursors to indicate
that was such a problem. Those being he only 45 years
old, no medical history of hypertension or cholesterol
problems. (He was a smoker and had a family history of
hypertension and hypercholesterol.)

On or about Sept 22, I demanded a referral to another
facility. Jack was air ambulanced to St. Mary's Hospital
in Rochester Minnesota and placed under the care of Mayo
Clinic Physicians. Before 24 hours were up, we had a
diagnosis of Mesenteric Ischemia. All three of his
mesenteric arteries were occluded and the position of the
occlusion would not allow surgery. Many medications were
administered in hope it would allviate the occlusion. He
was placed on Paraenteral feeding. Due to the paraenteral
feeding, he was then on Heparin, Insulin and very high
doses of steroids. Released to go home sometime around
early to middle October.

October 28, 2004 - Jack admitted to ER. Intolerable
abdominal pain, nausea, vomiting, diarrhea. Emergency
exploratory surgery performed. ALL of Jack's small and
large bowel have died and have began developing gangrene.
He is given 2-5 days to survive.

November 2, 2004, Jack died.

My research indicates there was enough complaints to
warrant testing for vascular problems in September. In
one specific article, mesenteric ischemial should be
considered when "postprandial abdominal pain and weight
loss; and is initially seen for abdominal pain that is out
of proportion to that suggested by physical examination.
Survival is approximately 50% when diagnosis occurs within
24 hous after onset of symptoms, but it drops sharply to
30% or less when diagnosis is delayed. His diagnosis was
delayed for over month!

Would this likely be a case for medical malpractice due to
delayed diagnosis?
I only have a couple of weeks to start action if so.

delayed diagnosis of mesenteric ischemia causing death, 7/26/06, by Shiela Mauldin.

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