Coronial

16 results for adhesions (post-surgical)

QLDhospital2015-07-08

Hamilton, Michael John - Non-inquest findings

72y · Male·Multiple organ failure due to sepsis caused by abdominal adhesions from previous…

…ected duodenal perforation based on CT findings; laparotomy was performed but found no perforation, only adhesions and possible pancreatitis (lipase 1080 U/L post-op). Key clinical lessons: (1) pre-operative lipase test…

surgeryintensive carediagnosticsystemwarfarin
VIChome2014-03-17

Finding into death of Marcus Michael Christopher Charles

0y · Male·Complications of small bowel obstruction due to post operative adhesions

Marcus Charles, a 3-month-old neonate, died from small bowel obstruction due to postoperative adhesions following earlier surgical repair of oesophageal atresia and duodenal atresia. On 4 November 2006, param…

emergency medicineparamedicinediagnosticcommunicationranitidine
TAShospital2014-03-14

Coroner's Finding: Little, Neita Jean

79y · Female·aspiration pneumonia caused by aspiration of emesis secondary to small bowel obs…

…ed by small bowel obstruction post-hysterectomy surgery. The obstruction resulted from both pre-existing adhesions and a post-operative haematoma at the surgical site. Critical clinical lessons: (1) repeated vomiting un…

gynaecologyanaesthesiadiagnosticcommunicationrivaroxaban
SAhospital2000-07-21

Coroner's Finding: HOWIESON Julie Ann

43y · Female·sepsis secondary to extensive acute peritonitis following perforation of small b…

…oration 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-operative…

gynaecologyanaesthesiadiagnosticdelay
TAShospital2021-02-03

Coroner's Finding: Boon Alison Kim

51y · Female·peritoneal sepsis with multiple organ failure due to perforation of bowel by for…

… May 2018 and underwent emergency laparotomy; initial surgery missed the bowel perforation due to pelvic adhesions. A second operation identified and resected the perforation, but sepsis developed despite intervention. …

general surgerycolorectal surgerydiagnostic
SAhospital2011-08-05

Coroner's Finding: LEONARD Emily Ruth and HILLMAN Glenys Anne

Female·Emily Ruth Leonard: multi-organ failure due to overwhelming sepsis from a perfor…

…injury risk. Key clinical lessons: careful consideration of surgical approach in patients with extensive adhesions; heightened vigilance for early peritonitis signs post-complex abdominal surgery; appropriate drain plac…

gynaecologyintensive carediagnosticproceduralheparin
VIChospital2018-03-29

Finding into death of Roy Irvin Dorner

64y · Male·Complications of redo thoracotomy/aortic valve replacement in a man with ischaem…

A 64-year-old physician with significant cardiac history (prior CABG, pacemaker, congestive failure, and newly severe aortic stenosis) underwent redo thoracotomy for aortic valve replacement. During sternal re-entry, the…

cardiothoracic surgerycardiology
SAhospital2022-10-27

Coroner's Finding: Rentoulis Dimitrios

79y · Male·Iatrogenic right ventricular injury complicating drainage of pericardial collect…

A 79-year-old man died from iatrogenic right ventricular injury sustained during attempted drainage of a post-operative pericardial effusion following coronary artery bypass grafting. During a minimally invasive sub-xiph…

cardiothoracic surgeryanaesthesiaproceduralwarfarin
SAhospital2005-06-03

Coroner's Finding: SORENSEN Ruth Bengta Maria

69y · Female·faecal peritonitis due to small bowel obstruction and perforation due to periton…

… the next morning from faecal peritonitis due to small bowel obstruction and perforation from peritoneal adhesions. The coroner found the standard of care was seriously inadequate. Critical lessons: elderly patients wit…

emergency medicinesurgerydiagnosticcommunicationprochlorperazine
NThospital2018-09-21

Inquest into the death of David Fensom

67y · Male·multi-organ failure due to septic shock consequent on faecal peritonitis due to …

David Fensom, 67, underwent elective fundoplication for hiatus hernia and reflux on 21 September 2010. He developed severe right-sided abdominal pain post-operatively. A laparoscopy on 8 October misinterpreted findings a…

general surgeryemergency medicinediagnosticcommunicationfentanyl
TAShospital2023-04-03

Coroner's Finding: RS - de-identified

1y · Female·infarction and volvulus of the small intestine due to adhesion from prior nephre…

…d initially appeared normal. Critical diagnosis of small bowel infarction due to volvulus (from surgical adhesions) was missed, delaying transfer to Royal Hobart Hospital until 1:46pm. By then the child was in shock and…

emergency medicinepaediatricsdiagnosticsystem
VIChospital2018-08-27

Finding into death of Bevan James Murrowood

56y · Male·Complications of a small bowel obstruction

…ortem imaging revealed a small bowel obstruction with air-fluid levels but no identifiable cause (likely adhesions). The clinical lesson is that bowel obstruction should be considered in patients with vomiting and deter…

general practiceemergency medicinediagnosticmacrogol
WAhospital- 27 May 2014

Inquest into the Death of Brian John DAVIES

57y · Male·Multiple Organ Failure and Intra-Abdominal Haemorrhage following Cholecystectomy

…ve laparoscopic cholecystectomy at a regional hospital. The procedure was converted to open due to dense adhesions and obesity. Post-operatively, he developed progressive hypoxia and signs of acute renal failure within …

surgeryanaesthesiasystemdelaymorphine
SAhospital2008-09-19

Coroner's Finding: ALLEN Richard Grant

60y · Male·haemopericardium due to rupture of right ventricle complicating removal of cardi…

Richard Allen, a 60-year-old man with a permanent pacemaker for sick sinus syndrome, died from haemopericardium due to rupture of the right ventricle during pacemaker lead extraction on 2 November 2005. The 14mm perforat…

cardiologyanaesthesiadiagnosticdelaypropofol
NSW2024-05-17

Inquest into the death of Vicki Higgins

48y · Female·Ischaemic bowel; coronary artery disease, diabetes mellitus and Crohn's disease …

Ms Vicki Higgins, a 48-year-old woman with diabetes, Crohn's disease (with prior colectomy and ileostomy), and coronary artery disease, died from ischaemic bowel on day 17 of incarceration at Junee Correctional Centre du…

general practicegastroenterologydiagnosticcommunicationinsulin
NSW2018-10-26

Inquest into the death of Mahmoud Houri

27y · Male·multiple organ failure due to the consequences of multiple gunshot wounds to the…

Mahmoud Houri died aged 27 in custody from multiple organ failure, a consequence of gunshot wounds sustained in 2002. The inquest examined whether appropriate care was provided on 21 August 2008 when he presented with vo…

general surgerygastroenterologymetoclopramide

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