Undiagnosed Intestinal Volvulus Leads to Brain Damage in Child

This pediatric radiology case involves a six-year-old boy who was in distress and taken to a community emergency late in the evening. The patient complained of severe abdominal pain and unrelenting bilious vomiting. The patient was sent for abdominal X-rays that were reviewed by an offsite radiology service. The unofficial report stated that no abdominal abnormality was evident and the patient was sent home. The boy’s condition rapidly worsened at home and he was rushed to another facility. The patient coded several times on route to the hospital and was resuscitated but unfortunately sustained major brain damage. It was determined post-mortem that the patient suffered from an intestinal volvulus that ruptured after not being diagnosed for an extended time period. The patient is wheelchair bound and fully dependent for all activities of daily living.

Question(s) For Expert Witness

1. What is the standard of care in diagnosing this condition and what is the prognosis if diagnosed in a timely manner?

Expert Witness Response E-000959

The standard of care in this situation is that the radiologist must review the x-ray within twenty-four hours, and if there is a disagreement between the reading of the ER doctor and the radiologist, the latter must contact the ED. The ED then has the responsibility to follow up on this matter. The prognosis of midgut volvulus depends on prompt recognition before bowel necrosis occurs. In general, rapid diagnosis and immediate intervention for correction improve overall prognosis in all age groups. Younger children are at higher risk and require more aggressive support and treatment. Patients with other congenital defects have a poorer prognosis, depending on the severity of the abnormality.