Finding into death of Waisele Qalubau

39y · Male·Complications of large bowel pseudo-obstruction

A 39-year-old man with schizo-affective illness, hepatic cirrhosis, and substance abuse history died from complications of large bowel pseudo-obstruction with aspiration pneumonia. He had been admitted involuntarily for acute psychosis and underwent manual rectal dis-impaction and enemas on 2 February 2017. He collapsed with faecal vomiting, aspiration, and bowel obstruction, requiring intubation and ICU care. Despite aggressive management including colonoscopy and laparotomy, he deteriorated from ischaemic bowel changes and multi-organ failure. The coroner found his medical care reasonable and appropriate. Clinical lessons include recognition that constipation can be a serious complication in patients on multiple antipsychotics, particularly those with cirrhosis; earlier recognition of bowel obstruction risk; and coordination between psychiatry and medical teams when managing patients with complex comorbidities requiring psychotropic medications with gastrointestinal side effects.