Mead, Gwendoline

73y · Female·Multiple organ failure due to or as a consequence of sepsis due to or as a consequence of rectal and caecal adenocarcinoma (surgically treated)

73-year-old woman died 12 days after elective colorectal surgery for synchronous caecal and rectal tumours. Post-operatively, she developed persistent low urine output and intermittent hypotension managed with repeated fluid challenges and diuretics. Despite these interventions, she became fluid-overloaded with declining renal function. She deteriorated on day 6 with urosepsis and acute kidney injury requiring ICU admission. After initial improvement, she was discharged back to the surgical ward on day 8 but deteriorated overnight and required ICU readmission. She then suffered a femoral artery injury during attempted arterial line insertion, leading to uncontrolled bleeding, coagulopathy and ultimately death. Clinical lessons include: (1) the importance of early medical review for unexplained persistent post-operative low urine output that doesn't respond to standard treatment; (2) recognising evolving acute kidney injury even when creatinine remains normal, using urine output criteria; (3) improved inter-team communication and formal referral systems; and (4) consideration of early senior medical input when recurring problems aren't resolving with repeat interventions.