A Missed Bowel Perforation –the Importance of Diagnostic Reasoning Leah Timbag, MD, MPH, Voltaire R. Sinigayan, MD, and Mithu Molla, MD, MBA | September 27, 2023

A Missed Bowel Perforation –the Importance of Diagnostic Reasoning Leah Timbag, MD, MPH, Voltaire R. Sinigayan, MD, and Mithu Molla, MD, MBA | September 27, 2023 https://psnet.ahrq.gov/web-mm/missed-bowel-perforation-importance-diagnostic-reasoning This WebM&M Spotlight Case with CE/MOC, describes the failure to identify a brewing abdominal process, which over the span of hours led to fulminant sepsis with rapid clinical deterioration and eventual demise. The patient’s ascitic fluid cultures and autopsy findings confirmed bowel perforation, but this diagnosis was never explicitly considered. The commentary discusses the importance of early identification of sepsis, the role of biomarkers and risk scores in conjunction with bedside examinations to assess patients with suspected sepsis, and approaches to improve the prognosis of patients in septic shock, such as protocolized sepsis bundles.