Coroner's Finding: Flynn, Christine Joy
Deceased
Christine Joy Flynn
Demographics
68y, female
Date of death
2023-12-05
Finding date
2024-11-07
Cause of death
haemopericardium resulting from perforation of the pericardial sac during laparoscopic hiatus hernia repair
AI-generated summary
Mrs Christine Flynn, aged 68, died from haemopericardium and pericardial tamponade following laparoscopic hiatus hernia repair. A 2mm perforation of the pericardial sac occurred during surgery, likely from mesh tacks placed near the diaphragm. She developed hypotension two hours post-operatively, followed by nausea, collapse, and cardiac arrest. The coroner accepted expert opinion that mesh fixation with tacks in hiatus hernia repair carries catastrophic risks including pericardial injury, with no clear advantage over non-mesh repair. Clinicians should be alert to this risk and consider alternative fixation methods such as glue or avoid mesh entirely in hiatal hernia repairs.
AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes.
Error types
Clinical conditions
Contributing factors
- use of mesh tacks for fixation in hiatus hernia repair
- pericardial sac perforation during laparoscopic procedure
- lack of immediate recognition and intervention for post-operative deterioration
Coroner's recommendations
- Practitioners should be alert to the risks of use of tacks for mesh fixation in hiatal hernia repairs
- Consider using glue for mesh fixation as an alternative to tacks
- Consider avoiding mesh fixation entirely in hiatal hernia repairs
Full text
Related cases
Source and disclaimer
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.
Content may be incomplete, reformatted, or summarised. All court orders for redaction and non-publication are respected; documents with technically defective redaction have been excluded from the database entirely. Always refer to the original court publication for the authoritative record.
Copyright in original materials remains with the relevant government jurisdiction. AI-generated summaries and tagging are for educational purposes only, may contain inaccuracies, and must not be treated as legal documents. We welcome feedback for correction —