Coroner's Finding: BALNAVES Craig Henri
Deceased
Craig Henri Balnaves
Demographics
43y, male
Date of death
2009-05-09
Finding date
2013-08-27
Cause of death
ischaemic small intestine due to incarceration of bowel in a mesenteric defect
AI-generated summary
Craig Henri Balnaves, a 43-year-old man with treatment-resistant schizophrenia detained at Glenside Hospital under mental health orders, died from ischaemic small intestine due to bowel incarceration in a congenital mesenteric defect. He presented with abdominal pain on 8-9 May 2009 and was appropriately diagnosed with acute abdomen and transferred to hospital. Expert surgical review confirmed staff provided standard-of-care management. Mesenteric ischaemia is notoriously difficult to diagnose even in tertiary centres; symptoms are non-specific and often out of proportion to signs. The condition has 59-73% mortality even when diagnosed. Early overnight transfer might possibly have changed outcome, but there is no certainty a receiving hospital would have diagnosed it earlier. This case demonstrates the diagnostic challenge of rare acute surgical conditions presenting with atypical features in mentally ill detained patients.
AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes.
Drugs involved
Contributing factors
- congenital mesenteric defect trapping bowel
- compromise of blood supply to intestine
- progression to intestinal infarction
- cardiovascular collapse from massive blood and fluid loss
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