Finding into death of Penrin John Maxworth Halliday

60y · Male·Ischaemic gut secondary to superior mesenteric artery dissection complicating intra-aortic balloon pump

A 60-year-old man with severe coronary artery disease presented with acute myocardial infarction, requiring emergency stenting and subsequent bypass surgery. An intra-aortic balloon pump (IABP) was inserted for haemodynamic support. During IABP removal on post-operative day 1, the patient developed acute abdominal pain with elevated lactate. Imaging revealed superior mesenteric artery dissection with intestinal ischaemia—a recognised but uncommon complication of IABP. Despite emergency surgery and revascularisation, the bowel was profoundly ischaemic and non-viable. The coroner found the recognition of ischaemic gut was timely, surgical referral appropriate, and the IABP use justified given haemodynamic necessity. Key lesson: IABP complications must be recognised quickly; lactate monitoring was appropriately used to identify shock. Surgical delay due to competing emergency transplants was unavoidable but unfortunate.