Non Inquest Findings TO

73y · Male·Sepsis (gram-negative septic shock) secondary to complications of selective internal radiation therapy (SIRT) in a patient with previous Whipple procedure

A 73-year-old man died from gram-negative septic shock following selective internal radiation therapy (SIRT) for metastatic gastric cancer. He had previously undergone a Whipple procedure in 2014, which creates a direct communication between bowel and bile duct, increasing infection risk. Post-SIRT, he developed fever (37.8°C) and was discharged home on day 2 without antibiotic prophylaxis despite these risk factors. He deteriorated rapidly at home with septic shock and died in hospital despite resuscitation. The interventional radiologist failed to appreciate the significance of the prior Whipple procedure and its associated sepsis risk. Prophylactic antibiotics (ciprofloxacin and metronidazole) before, during and after SIRT would likely have prevented death. Key clinical lesson: when SIRT is performed in post-Whipple patients, prophylactic antibiotic cover is essential to prevent biliary sepsis from gram-negative bacteria colonising the altered biliary tree.