Searle, William Edward

74y · Male·Aspiration of gastric contents due to paralytic ileus following Whipple surgery for tubulovillous adenoma of the pancreatic duct

William Searle, a 74-year-old prisoner, died from aspiration of gastric contents following a Whipple procedure for recurrent ampullary adenoma. The clinical lessons involve recognition of gastroparesis risk in high-risk patients (diabetes, obesity, opioid use, post-major surgery). Multiple missed opportunities to recognize and manage gastroparesis occurred: on the evening of 1 March when abdominal distension and respiratory distress were attributed to ileus without consideration of NGT reinsertion; at 4:17am on 2 March despite clinical deterioration and abnormal blood work; and after the CTPA showing abdominal/oesophageal distension. Earlier reinsertion of the nasogastric tube, particularly on evening of 1 March, was deemed outcome-changing. The case highlights the importance of close communication between junior and senior staff when patients deviate from expected post-operative recovery parameters, and that ERAS protocols may not suit all high-risk patients including those with poorly controlled diabetes.