Finding into death of Eugene William Twining

88y · Male·Ischaemic bowel in a man with fractured pelvis secondary to a motor vehicle incident (pedestrian)

An 88-year-old man with mild cognitive impairment and recent depressive symptoms ran in front of a stationary truck on Burke Road Melbourne and was struck. He was admitted to Alfred Hospital with multiple pelvic fractures and developed acute kidney injury with abdominal pain. Imaging revealed portal vein thrombosis. Despite pain and delirium, no acute surgical intervention occurred. Post-mortem examination revealed ischaemic bowel secondary to aortic atheroma that likely embolised to the inferior mesenteric artery. The coroner identified that the truck driver could not see the patient due to poor cab design, not driver error. The key clinical lesson concerns recognition and investigation of acute abdominal pain in trauma patients with vascular risk factors, and timely intervention for acute mesenteric ischaemia.