A patient with a fast heart rate, decreased bowel sounds, and worsening abdominal pain may be facing a serious abdominal emergency. When these findings appear together, the standard approach focuses on two things at once: keeping the patient stable and finding the underlying cause.
Doctors and nurses use systematic, step-by-step evaluation methods so that the correct diagnosis is made and the patient receives prompt, accurate care. That begins with taking abnormal vital signs seriously and documenting them accurately. From there, the physician orders a workup that connects the fast heart rate to the abdominal symptoms, including laboratory tests and imaging that can confirm or rule out dangerous causes such as bowel obstruction.
Only after that workup should the physician settle on a diagnosis and begin targeted treatment. Skipping these steps can delay the diagnosis, allow the underlying condition to worsen, and cause serious complications.
That is what happened in this case.
Our client developed a bowel obstruction that perforated her colon and caused life-threatening peritonitis. Over two office visits, her physician failed to work up clear warning signs. He charted a normal heart rate when she was tachycardic, ordered no lab work at either visit, and prescribed medication that should not be given when an obstruction is suspected. The Townsley Law Firm represented her and recovered a settlement of over $625,000.
The Chart Said One Thing. The Patient’s Body Said Another.
Our client called her physician’s office after about a week of painful constipation and asked for an urgent appointment. The earliest she could be seen was four days later. At that visit, she reported sharp, diffuse abdominal pain rated 7 out of 10, a loss of appetite, and other symptoms. She told her physician she was worried she might have a bowel blockage.
Clinic staff recorded her heart rate at 102 beats per minute, which is tachycardic. The physician’s own exam note recorded a regular heart rate and rhythm instead. He noted decreased bowel sounds, diagnosed chronic constipation and acute abdominal pain, and ordered an abdominal x-ray. He did not order any lab work. He told her to drink magnesium citrate for three days and to return in one week.
The x-ray that afternoon showed a large amount of stool throughout her colon. A week later she returned with ongoing pain still rated 7 out of 10, bloating, and only small amounts of stool. She had lost 10 pounds over three months, her heart rate was 104, and her abdomen was now firm and distended. Again, no labs were ordered. No new imaging was ordered either.
A physician who documents a normal heart rate in a tachycardic patient has created a record that contradicts the patient’s true condition. That discrepancy is at the center of this case. Tachycardia, an abnormally fast heart rate, can point to infection, inflammation, or a serious abdominal process. Decreased bowel sounds point toward a bowel that is not working normally.
Together, in a patient with abdominal pain, these findings call for investigation. Documentation is supposed to be an accurate record of what the clinician found, because every later decision is built on it. When the record says the patient is fine while she shows signs of a serious problem, it papers over the exact findings that should have triggered a workup. That gap between the documented picture and the real one is powerful evidence that the evaluation fell below the standard of care.
Two Visits, Worsening Signs, and Still No Lab Work
Ordering basic lab work is a fundamental step when a patient presents abdominal pain and abnormal findings. The failure to order any labs across two separate visits and failure to order new imaging as her condition worsened, is the core negligence here. These tests are routine and inexpensive, and they are exactly what the situation demanded.
On the first visit, our client had tachycardia and decreased bowel sounds. On the second visit, she had a firm, distended abdomen, a finding more alarming than the first. Instead of ordering new tests, the physician relied on the week-old x-ray to rule out an obstruction. He then prescribed Linzess, a constipation medication, and told her to come back in two weeks.
That prescription mattered. The manufacturer’s prescribing information lists known or suspected mechanical gastrointestinal obstruction as a contraindication for Linzess. Our client had already raised concern about blockage, and her exam was getting worse. Without updated testing, her physician had no way to rule out an obstruction before prescribing the drug.
Each visit was a chance to catch a developing catastrophe with a routine test. Each chance was missed. This was not a single oversight. It was a pattern of failing to evaluate a patient whose condition was visibly worsening.
How a Missed Diagnosis Became a Life-Threatening Emergency
Just three days after her second visit, she called the office in pain and told staff she was going to the hospital. She arrived at the emergency room with abdominal pain, shortness of breath, and constipation. Her heart rate was 138.
The emergency room ordered the testing that should have happened in the office. A stat x-ray showed a dilated colon. A CT scan showed marked distension of the colon, a possible obstructing lesion, a cecum dilated to 13.5 centimeters, free fluid in the pelvis, and free air in the abdomen consistent with perforation.
By the time she was diagnosed, the obstruction had caused her colon to perforate and spill fecal material into her abdomen. She underwent an emergency exploratory laparotomy the same day. Surgeons found purulent material in the upper abdomen, feculent material in the lower abdomen, and a perforation in the cecum. A thickened area where the small intestine had adhered to the sigmoid colon was believed to be the cause of the obstruction.
Surgeons performed a right hemicolectomy, removing 37 centimeters of colon, and creating an ileostomy and colostomy. Her large midline incision was stapled with areas left open, and a drain was placed to reduce the risk of severe infection. She spent a prolonged stay in the hospital receiving IV antibiotics for severe peritonitis and went home with home health care for wound and ostomy care.
The harm did not stop there. Less than a month after discharge, she was readmitted for an urgent revision of her ileostomy. Just over a month later, high ileostomy output and poor intake caused dehydration and an acute kidney injury. Her kidney function declined to a diagnosis of Stage 4 kidney disease with hyperkalemia, and she needed IV hydration twice a week for a month.
She lost 25 pounds in less than three months and was treated for anxiety. Months later, she underwent another major operation to take down her ileostomy, remove more of her colon, and reconnect her bowel. She continues to live with chronic diarrhea that affects her daily activities and social life. This cascade of emergency surgery, kidney injury, multiple procedures, and prolonged recovery traces back to the failure to evaluate her when she first sought help.
