Texas Mesenteric Ischemia Malpractice: When Negligence Has a Price

Texas mesenteric ischemia medical malpractice cases revolve around the key issues of timely diagnosis and appropriate treatment.

Experienced Texas medical malpractice lawyers recognize the life-changing injury that patients face when they are diagnosed with ischemic bowel or bowel necrosis. When this happens because of the mistakes of a doctor, hospital, or nursing staff, a medical malpractice lawsuit can provide the resources needed to cover medical care, lost income, and to cope with the new reality.

What is mesenteric ischemia?

Mesenteric ischemia is a concerning and potentially life-threatening diagnosis that needs careful workup of doctors, with the help of nurses, lab personnel, and the radiology department. 

The mesentery is a highly vascularized structure that keeps the intestines in place. Ischemia refers to a lack of blood flow to the part of the body. When ischemia is severe, it can cause tissues to die (necrosis). Mesenteric ischemia is a condition where there's a lack of blood supply to the mesentery. In severe cases, it can result in the ischemic bowel or bowel necrosis, which is death of the bowel.

Different types of mesenteric ischemia

Gastroenterologists are medical specialists who deal with conditions of the gastrointestinal system. These experts divide mesenteric ischemia into two types: chronic and acute.

There is a significant difference between the two types of mesenteric ischemia. Chronic basically means a long-term condition. Chronic mesenteric ischemia isn't immediately life threatening. Acute means short-term. Acute mesenteric ischemia is a medical emergency.

One of the classic symptoms of chronic mesenteric ischemia is severe pain that occurs after eating. Physicians often described this as postprandial pain or abdominal angina. The pain is often so bad that people become scared of eating, leading to unintentional weight loss.

When you eat, there is an increased demand for blood supply. Patients with chronic mesenteric ischemia have plaque in one of the arteries supplying blood to the mesentery. The major ones are the celiac artery, superior mesenteric artery, and inferior mesenteric artery. Plaque building up on the arterial walls reduces blood flow to the mesentery. The severe pain after eating is caused by the arteries not being able to keep up with the demand is a plaque.

Chronic mesenteric ischemia is treatable with a surgical procedure called revascularization.

Acute mesenteric ischemia is more serious and life-threatening condition that places a person in danger of ischemic bowel. There are two ways the acute condition can develop. The first involves a blood clot or embolus that blocks one of the arteries that supplies the mesentery, often the superior mesenteric artery. This is a similar mechanism to the way a heart attack or myocardial infarction occurs. The second way acute mesenteric condition occurs is as a progression of chronic mesenteric ischemia. In these situations, the plaque gets so bad that it leads to an acute event.

Unfortunately, by the time acute mesenteric ischemia is recognized, gastroenterology experts find that the patient already has necrotic bowel. This means that all or part of the bowel will need to be surgically removed.

Diagnosing mesenteric ischemia

When a gastroenterologist, internal medicine specialists, or other physician suspects mesenteric ischemia in the differential diagnosis of a patient's complaints of ongoing abdominal pain after eating and unintentional weight loss, the standard of care requires orders for radiology imaging. Experts contend that the best scan is a biphasic CT with mesenteric CT angiography.

One of the risks of diagnosing and treating mesenteric ischemia occurs when the physician or medical team stops the workup before ruling out chronic mesenteric ischemia. In a hospital setting, this can happen because a patient with this condition can feel dramatically better with rest and intravenous (IV) fluids.

Lewis' tragic misdiagnosis

That's what happened to a client of ours in San Antonio, who went to an area hospital after a few weeks of unintended weight loss in pain after meals. Let's call him Lewis.

Lewis went to the emergency room (ER) and was admitted to the hospital. The medical team recognized that he had serious problems, including seriously abnormal lab work including a huge anion gap and elevated lactic acid. The hospitalist who was Lewis's attending physician noted in the medical record that mesenteric ischemia was on the differential diagnosis list.

Yet, after the hospitalist ordered IV fluids, antibiotics, and rest, Lewis began to feel better. Instead of continuing the diagnostic workup to exclude the possibility of chronic mesenteric ischemia, the hospital was discharged from the hospital with the rather harmless diagnosis of viral gastritis.

The doctor and nursing staff didn't say a word to Lewis about the possibility might have this condition, and recommended that he follow-up as an outpatient with his general practitioner and a gastroenterologist.

Lewis followed those inadequate discharge instructions and saw the two recommended physicians, who relied on the discharge diagnosis of viral gastritis. No one seemed to think anything more about the possibility of chronic mesenteric ischemia, for the next few months, even though Lewis continued to lose weight unintentionally and experience severe abdominal (epigastric) pain after meals.

Unfortunately, the next trip that Lewis took to the hospital, about four months after his first admission, led to a life-changing diagnosis of acute mesenteric ischemia. By then, though, his bowel was ischemic and necrotic. The surgeons had to remove his entire small intestines and a big part of his large intestines to save his life.

Unless Lewis is fortunate enough to be able to have a bowel transplant, he will have to live the rest of his life receiving nutrition from an IV line called total parenteral nutrition (TPN), rather than eating and drinking as a normal person. Because of chronic malnutrition weakness, there's no way that Lewis will be able to return to work. This means his family suffered a significant loss of income.

Sadly, this all could have been avoided if the hospitalist and medical team during the first admission, as well as the physicians who handled outpatient care for Lewis, had exercised basic critical thinking and given appropriate orders to rule out chronic mesenteric ischemia.

In a Texas medical negligence lawsuit, any patient who is injured by negligence can recover damages for medical expenses, lost income, mental anguish, and pain and suffering, among other types of damages.

If you've been seriously injured because of poor gastroenterology care involving mesenteric ischemia in Texas, then contact Robert Painter at 281-580-8800, a top-related, experienced Texas medical malpractice attorney, for a free consultation about your potential case.

Article by

Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.