Coroner's Finding: GIANNINI Pasquale

68y · Male·infarction of the small and large bowel due to superior mesenteric artery thrombosis

A 68-year-old man with extensive systemic vascular disease presented with 10 days of nonspecific abdominal pain. Initial presentations at local hospital and GP were attributed to possible gallstones or gastritis based on CT findings of a solitary gallstone, though the same CT showed concerning SMA changes suggesting chronic thrombosis with collateral development. The patient deteriorated over several days with worsening pain. When readmitted on day 10, the treating surgeon focused on symptomatic management rather than pursuing urgent investigation for mesenteric ischaemia. By the time mesenteric ischaemia was suspected the following morning and imaging arranged, irreversible bowel necrosis had occurred. The coroner found that earlier recognition of mesenteric ischaemia as a differential diagnosis—particularly by 10 November evening—might have enabled vascular intervention with a 90% chance of bowel salvage. However, the coroner acknowledged the notorious diagnostic difficulty of acute mesenteric ischaemia, noting that premorbid diagnosis remains exceptional rather than routine in clinical practice.