Finding patience,iandonald 970 07

68y · Male·Complications following colon surgery on a background of cirrhosis of the liver; specifically anastomotic leak leading to sepsis, hepatic encephalopathy, and multi-organ failure

Ian Donald Patience, 68, died on 10 June 2007 from complications following colon surgery in the setting of cirrhosis. He underwent right hemicolectomy at Sydney South West Private Hospital on 31 May 2007 for colorectal cancer. Post-operatively, he developed massive ascites and hepatic encephalopathy. Key clinical lessons: cirrhosis severity was not adequately assessed or communicated to all treating clinicians; performing high-risk surgery at a small private hospital without specialist gastroenterological support or ICU was inappropriate; post-operative fluid management was inadequate (excess saline given when sodium restriction was needed); gastroenterological input was not sought early; and transfer to specialist care should have occurred earlier when complications became apparent. An anastomotic leak required emergency surgery on 9 June, but by then multi-organ failure had developed. The coroner recommended comprehensive guidelines for perioperative assessment and management of cirrhotic surgical patients.