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Delay in treating man with acute abdominal pain (10HDC00950)
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(10HDC00950, 12 June
General surgeon ~ Public hospital ~ District health board ~
Delay in surgery ~ Acute pain ~ Hernia ~ Right 4(1)
This case concerns the untimely surgical management of acute
abdominal pain. A 79-year-old man presented to the emergency
department at a public hospital with new, sudden onset, severe pain
in his longstanding inguinal hernia. Intravenous morphine was given
by ambulance staff and again in ED for pain rated 10/10 in
A surgeon saw the man approximately two hours after the onset of
his pain. He made a diagnosis of a painful, irreducible hernia,
which required surgery, but not as an emergency. The surgeon
admitted the man for observation overnight. The man continued to
report severe pain overnight, requiring morphine.
Care was handed over to the on-call surgeon the following
morning. This surgeon agreed with the diagnosis of irreducible
hernia and operated that afternoon. During surgery, it was found
that the man had a small bowel volvulus and over two metres of dead
bowel was removed.
It was held that although the diagnosis of volvulus may not have
been expected, the doctors should have recognised that the man was
suffering a major intra-abdominal insult that required emergency
The first surgeon's assessment, and his decision to delay
surgery until the next day, were inappropriate and a breach of
The on-call surgeon's failure to recognise that the man required
urgent surgery was also a breach of Right 4(1).
The DHB provided ED and nursing care of a reasonable standard,
and emergency operating services were available at all times if his
surgeons had felt this was needed. The DHB was found not to have
breached the Code.