Deceased
Mr P
Demographics
64y, male
Date of death
2012-10
Finding date
2016-06-27
Cause of death
Small bowel infarction due to a volvulus owing to adhesions in the small intestine
AI-generated summary
Mr P, aged 64, presented to Royal Hobart Hospital's Emergency Department in October 2012 with severe central abdominal pain. The ED consultant diagnosed bowel obstruction but failed to consider critical complications such as strangulation, perforation, and peritonitis. Upon admission to the ward, a surgical registrar identified signs of complicated obstruction but either failed to understand or did not appropriately act on these critical findings. The cause of death was small bowel infarction due to volvulus from pre-existing adhesions. The coroner found the standard of care fell well below acceptable standards and that the condition was "eminently survivable" with proper diagnosis and treatment. This represents a preventable death caused by diagnostic failure and inadequate clinical assessment.
AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes.
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