Ronald Turner, an 81-year-old man in lawful custody, died from consequences of bowel obstruction with aspiration pneumonia. He had a history of recurrent sigmoid volvulus despite previous surgery. On 22 January 2020, he reported abdominal symptoms; initial assessment was reasonable. On 23 January, he deteriorated acutely with low blood pressure and vomiting, appropriately transferred to hospital. Flexible sigmoidoscopy achieved successful decompression. However, unexpected vomiting on 25 January led to aspiration pneumonia and respiratory distress requiring ICU admission. The coroner found no clinical indication for earlier escalation, that care was appropriate throughout, and that the outcome reflected natural disease progression in a medically frail 81-year-old rather than any deficiency in medical management.
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Specialties
colorectal surgerygeriatric medicineemergency medicineintensive care
Clinical conditions
sigmoid volvulusbowel obstructionaspiration pneumoniainsulin-dependent type II diabetes mellituschronic psychosishypertension
Procedures
flexible sigmoidoscopydecompression of sigmoid volvulusnasogastric tube insertion
Contributing factors
recurrent sigmoid volvulus
aspiration pneumonia secondary to vomiting
medical frailty in advanced age
inability to coordinate vomiting to avoid aspiration
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