SHM Converge Scientific Abstract ePoster Gallery-Diagnostic Error in a Patient With Life-Threatening Anemia and Severe Gastrointestinal Hemorrhage

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This case describes a 76-year-old woman with CAD, hypertension, CKD, and known diverticulosis who presented after recent hip arthroplasty with profound weakness, dyspnea, hypotension, and severe anemia. Early evaluation was misdirected by left thigh edema, leading clinicians to suspect a postoperative hematoma rather than gastrointestinal bleeding. Stool was later noted to be dark, and an urgent EGD found a small oozing duodenal ulcer plus minor gastric erosions, which likely contributed to anchoring on an upper GI source.<br /><br />Despite ongoing blood loss, including black stools followed by hematochezia and hemodynamic instability, repeat EGD was negative. Colonoscopy was delayed several days and ultimately showed moderate diverticulosis with stigmata of recent bleeding, supporting a concurrent diverticular lower GI bleed. The final diagnosis was severe gastrointestinal hemorrhage likely from diverticular bleeding, preceded by a subacute duodenal bleed.<br /><br />The case highlights several contributors to diagnostic error from the UPSIDE framework: overvaluing an incidental physical finding (thigh edema), anchoring on the first identified lesion, inadequate weighting of known diverticulosis and evolving hematochezia, delayed expansion of the differential, limited collaboration between primary and consulting teams, and weekend-related delays in colonoscopy. The authors suggest that earlier consideration of dual pathology and same-day EGD plus colonoscopy might have expedited diagnosis and treatment, potentially reducing harm and length of stay.

Asset Subtitle

Nickie Burney

Meta Tag

Author List Anuj K. Dalal, Danielle A. Moore, Jeffrey L. Schnipper, Nickie Burney

Category Clinical Vignettes

Concept Anchoring Bias

Concept Confirmation Bias

Concept Gastrointestinal Bleeding

Concept Severe Gastrointestinal Bleeding

Concept Endoscopic Evaluation

Distinguished Non-Finalist

Presenter Organization Brigham & Women's, Brigham & Women's Faulkner, Boston College

Presenting Author Nickie Burney

Track Adult

Keywords

gastrointestinal hemorrhage

diverticular bleeding

duodenal ulcer

diagnostic error

anchoring bias

hematochezia

melena

colonoscopy

upper GI bleed

postoperative anemia

Anchoring Bias

Confirmation Bias

Gastrointestinal Bleeding

Severe Gastrointestinal Bleeding

Endoscopic Evaluation