Coroner's Finding: HOWIESON Julie Ann

43y · Female·sepsis secondary to extensive acute peritonitis following perforation of small bowel wall

43-year-old woman died from sepsis and necrotising fasciitis following small bowel perforation 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-operatively, she presented with severe pain requiring narcotic analgesia within 24 hours—a red flag for bowel injury. Despite fluctuating clinical course, peritonitis and bowel perforation were not recognised until late (day 6), when bowel contents began draining from the umbilical wound. Had a laparotomy been performed on day 1-2 based on clinical suspicion, earlier intervention might have prevented progression to overwhelming sepsis. The coroner emphasised maintaining high index of suspicion for bowel injury post-laparoscopy, particularly in high-risk patients, and noted that post-operative pain should be assumed bowel damage until proven otherwise.