Misdiagnosis of mesenteric ischemia typically has catastrophic implications for the patient. Time is of the essence with this condition; delayed diagnosis can mean death or serious damage to vital organs. The New England Journal of Medicine (NEJM) published a review this month detailing the causes, symptoms and treatment for this condition which accounts for as a many as 1 in 2,000 hospital admissions.
Mesenteric ischemia refers to interruption of blood flow to vital organs in the abdomen and pelvis due to an obstruction in the arteries that supply blood to this area. An obstruction can be caused by a blood clot, dissection of the artery, or injury. Most cases are associated with progression of atherosclerosis.
Timely diagnosis is dependent upon a careful evaluation by the doctor on presentation. Risk factors include preexisting atherosclerosis, like kidney or heart disease, and being female. 70% of cases involve women. The key presenting symptom is severe abdominal pain, although in some circumstances the pain can be masked. Pain may be associated with eating, which can result in unintended weight loss. Nausea, vomiting and diarrhea may also be present. Lab tests and imaging are used to make the diagnosis.
Treatment of Mesenteric Ischemia
Treatment of mesenteric ischemia begins with fluid management and medications to dilate blood vessels and to prevent clotting. More advanced treatment depends on the cause and location of the ischemia, but may include surgery to fix a dissected vessel or to remove an obstruction.
Delayed diagnosis of mesenteric ischemia may result in wrongful death, loss of bowel or damage to other vital organs. As a medical lawyer who has investigated thousands of cases involving claims of medical negligence, the inquiry starts with a careful review of medical records and, when applicable, the autopsy. A misdiagnosis alone is not sufficient to support a lawsuit. A meritorious claim depends on whether the diagnosis of mesenteric ischemia should have been considered along with other conditions that may explain the patient’s signs and symptoms. If there were sufficient risk factors and symptoms to make a reasonable physician consider the diagnosis, then the next step is to see if the physician ordered adequate lab tests and imaging to rule the condition in or out. A case might lie in unexplained or unnecessary delays in obtaining proper testing, or in miscommunication of, misinterpretation of or unread test results.
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