Case Archive
Radiology, Family Practice
Ref. # 86397

A 59 year old Florida man had a long history, more than five years, of intermittent abdominal pain, nausea, vomiting and diarrhea. He saw his family practitioner after a severe attack of these symptoms. He was referred to a gastroenterologist, who ordered bloodwork including H. pylori and a small bowel follow-through. A radiologist reported the small bowel was normal. The H. pylori was positive and he gastroenterologist prescribed medication for the infection. Two years later the patient was admitted to the ER after another severe attack that had lasted two days. The family practitioner referred him to a surgeon. A CT scan of the abdomen showed an abnormal bowel. The patient was discharged with instructions to visit the family practitioner in two weeks. He did not. Eighteen months later the patient was admitted to the ER with the same symptoms. An internist, consulting with an oncologist and another surgeon, ordered a CT scan, which showed extensive pelvic adenopathy, most likely representing a lymphoma and a partial bowel obstruction. An exploratory laparotomy with a small bowel resection revealed an extensive lymphoma involving the mesentery and extending into the retroperitoneum, internal iliac and external iliac lymphatic region. Pathology of removed lymph nodes indicated Stage IV non-Hodgkin's lymphoma arising from the mucosa. The patient underwent extensive chemotherapy. A medQuest radiologist reported the small bowel series was negligently misinterpreted. There were two areas of abnormality, which was confirmed by the CT scan two years later. A medQuest family practitioner reported the patient's family practitioner negligently failed to follow up on and document the CT scan. Even though the patient did not appear for the appointment in two weeks as was instructed, it was the physician's responsibility to follow up because he had ordered the exam.

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