Malpractice: Gastrointestinal Perforations and Bowel Sepsis


Unfortunately, Medical Malpractice happens every day.  We hear it often- “My [loved one] went into the hospital for a simple procedure and never came home.”

At Cuthbert Law Offices, much of our time is devoted to medical malpractice litigation.  One common cause of medical malpractice lawsuits is doctor negligence that occurs during cases of intestinal perforations, peritonitis, and sepsis.  In this blog, we will examine the significance of mistreating or misdiagnosing an intestinal perforation.

Intestinal Perforations

An intestinal perforation is a hole that develops through the wall of the esophagus, stomach, small intestine, large bowel, rectum, or gallbladder. This condition is a medical emergency.

Causes of Intestinal Perforations

A variety of conditions can cause intestinal perforations.  Often, the causes of intestinal perforations include obesity, ulcers, appendicitis, gastrointestinal cancer, diverticulitis, inflammatory bowel disease, diet, and prolonged constipation. Commonly, we see intestinal obstructions that turn into perforations.  For example, an intestine complicated by a twisting, thus cutting off the natural flow through the intestine.  This twisting does not cause the perforation itself, it simply causes an obstruction.  However, the obstruction, if left untreated, can develop into a perforation.

Preventing an Intestinal Perforation

The good news is that, at least in some cases, you can minimize the risk of developing an intestinal perforation.  The following actions when taken can help prevent an intestinal perforation; maintain a healthy diet, exercise, inform your primary care physician of constipation that prevents normal elimination for more than a day, and thereafter become an advocate for your health by giving your primary care physician (PCP) daily updates until your system returns to normal.

A Real Example of a Perforated Hernia

See the exhibit below from one of our previous medical malpractice cases.  In this case, our client’s wife died.  She had a herniated intestine that twisted, became necrotic, and perforated.

Once her intestine was perforated, the contents of her bowel seeped out into her abdominal cavity causing a severe infection (sepsis), ultimately leading to her death.  Careful and responsive medical treatment would have prevented her death. She had the all the warning signs of peritonitis- her stomach was severely painful to the touch, she was complaining of 10/10 pain, she had not had a bowel movement for 5 days (despite being given 4 different constipation medications), her urine output was weak, she had a hernia the size of a softball. . . and yet, the physician prescribed laxatives day after day while our client lingered in the hospital.  The treating physician finally ordered an X-ray but failed to follow up on it.  Instead, the doctor let her keep drinking her laxative and went home for the day.  The next day she was in septic shock.  One day later she died.

Imagine your intestines as piping.  As the piping gets obstructed (clogged), it backs up, causing more pressure on the piping.  If the pressure is not relieved, the pressure can cause the piping to burst (perforate).

Once the intestine perforates, the patient is at a greater risk of widespread infection (sepsis).  This is because the bursting pipe (perforation) can cause the contents of the patient’s bowel (intestine) to spill out into the stomach cavity causing peritonitis.  Peritonitis is a serious infection that can turn into sepsis, and potentially, lead to death.

Symptoms of Peritonitis

The symptoms of peritonitis are:

  • The stomach is very painful or tender
  • The stomach pain may become worse when touched or upon movement
  • Fever and chills
  • Fluid in the abdomen
  • Passing little or no stools or gas
  • Excessive fatigue
  • Passing less urine
  • Nausea and vomiting
  • Racing heartbeat
  • Shortness of breath

To put the severity of an intestinal perforation in context, it has been explained to me (by one of our medical experts) as equivalent to a child drowning.  You do not stand by and watch to see what happens.  You dive in and bring the child to safety.  If someone has a perforation, immediate action is required.


If left untreated (hours or days), perforation can lead to Sepsis.  Sepsis is a life-threatening complication of the infection process. It occurs when the body’s attempt to fight the infection (peritonitis) ends up harming the other organs in the body. (Kind of like the body running a temperature to fight an infection.  If the temperature gets too high, the body’s response becomes harmful rather than helpful).  The body’s fight against the infection, triggers inflammation throughout the body doing damage to multiple organ systems, causing them to fail.

Sepsis can be treated if it is caught early enough to get the infection under control and reverse the inflammation process.  If sepsis is left untreated, it becomes what is known as “severe sepsis” or “septic shock.”  This is the point of no return.  Once a person enters septic shock, the chances of survival are very low.

Scenarios of Potential Malpractice

The process of obstruction, to perforation, to peritonitis, to sepsis, to septic shock, can take weeks, days, or hours.

Here are some potential pitfalls where medical malpractice can occur:

  • Misdiagnoses of constipation – In some instances, a doctor will diagnosis a bowel obstruction as constipation and prescribe laxatives.  While this isn’t malpractice, if the “constipation” is not relieved by laxatives (which it won’t be) and is accompanied by complaints of severe pain, simply prescribing more powerful laxatives may be malpractice.
  • Failure to Communicate – For example, a radiologist reads an MRI or CT showing a perforation (a medical emergency), but the radiologist fails to communicate the emergency to a treating physician.  Instead, the doctor makes a note in the chart and continues about his business.  The patient then dies because no one was alerted to the emergency.  A variation on this theme, is when the radiologist only communicates the emergency with a floor nurse not another physician, this can also constitute negligence.
  • Failing to Order Timely Films (X-ray, MRI, CT)- As discussed above, a perforation is a medical emergency.  It is a life-and-death situation.  If a perforation is suspected, the appropriate films must be ordered immediately.  Those films must be followed up on.  There is no benefit to just getting the films done.  The results must be read and acted upon in a timely manner.
  • Misreading or Misinterpreting Films- A busy doctor looks at the films and doesn’t see the tell-tale signs of a perforation.  Or, a doctor looks at the films, but does not read the accompanying report documenting the emergency.

Acute stomach pain must be taken seriously and treated seriously. Too often complaints of severe abdominal pain are written off by doctors as constipation or some other less critical condition.

Contact Our Virginia Medical Malpractice Lawyers

At Cuthbert Law Offices we’re medical malpractice lawyers that specialize in litigation for medical malpractice by negligent doctors.  Email us at or call us at (804) 485-2555.  We are available 24 hours a day.