Coronial
SAhospital

Coroner's Finding: HOWIESON Julie Ann

Deceased

Julie Ann Howieson

Demographics

43y, female

Date of death

1998-06-03

Finding date

2000-07-21

Cause of death

sepsis secondary to extensive acute peritonitis following perforation of small bowel wall

AI-generated summary

43-year-old woman died from sepsis and necrotising fasciitis following small bowel perforation during laparoscopic tubal ligation. She was at high risk due to previous abdominal surgeries and adhesions. A 4-5mm perforation occurred during the procedure but was not detected intraoperatively. Post-operatively, she presented with severe pain requiring narcotic analgesia within 24 hours—a red flag for bowel injury. Despite fluctuating clinical course, peritonitis and bowel perforation were not recognised until late (day 6), when bowel contents began draining from the umbilical wound. Had a laparotomy been performed on day 1-2 based on clinical suspicion, earlier intervention might have prevented progression to overwhelming sepsis. The coroner emphasised maintaining high index of suspicion for bowel injury post-laparoscopy, particularly in high-risk patients, and noted that post-operative pain should be assumed bowel damage until proven otherwise.

AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes. Report an inaccuracy.

Specialties

gynaecologyanaesthesiageneral surgeryintensive care

Error types

diagnosticdelay

Clinical conditions

small bowel perforationacute peritonitisnecrotising fasciitisabdominal adhesionssepsisbowel fistulasurgical emphysema

Procedures

laparoscopic tubal ligationlaparotomyperitoneal lavagedebridement of necrotic tissue

Contributing factors

  • small bowel perforation during laparoscopic tubal ligation
  • pre-existing abdominal adhesions from previous surgery
  • failure to recognise peritonitis and bowel damage early post-operatively
  • delayed laparotomy (6 days post-operation)
  • widespread necrotising fasciitis of anterior abdominal wall
  • conservative management despite red flag symptoms
  • inadequate intraoperative inspection for bowel damage

Coroner's recommendations

  1. Gynaecologists using laparoscopic surgery should be reminded of the small but appreciable risk of damage to bowel and/or major blood vessels
  2. Patients who have undergone previous abdominal surgery are at significantly increased risk of bowel damage and suitability for laparoscopic surgery should be carefully considered
  3. Alternative entry sites to the abdominal cavity should be considered if adhesions are suspected
  4. Any unusual symptomatology after laparoscopic surgery should give rise to a 'very high index of suspicion' that bowel or blood vessel damage may have occurred and that laparotomy may be indicated
  5. The need for early intervention in cases of suspected bowel injury should be borne in mind
  6. Surgeons should consider routine inspection of bowel at conclusion of laparoscopic procedure in high-risk patients
  7. Patients and doctors should expect progressive and maintained improvement after laparoscopic surgery; increasing pain or vomiting should alert to real risk of complications
  8. Increasing pain should be assumed to be a consequence of bowel damage until proven otherwise
Full text
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This page reproduces or summarises information from publicly available findings published by Australian coroners' courts. Coronial is an independent educational resource and is not affiliated with, endorsed by, or acting on behalf of any coronial court or government body.

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