Mortality meeting of June 2019 and July 2019 of Dhaka Medical College Hospital, Dhaka Surgery Unit IV

1. Welcome

2. Mortality meeting
June – July 2019
Presented by:
Dr. A. K. M. Lutful Haque
MS(General Surgery) Part III student
Surgery Unit IV, DMCH

3. Total
Dead
0
50
100
150
Admitted Pt Male Female
135
77
5812 6
Mortality of June 2019
Total Dead
Mortality rate: 8.88%
6

4. Total
Dead
0
10
20
30
40
50
60
70
Emergency Opt Routine Opt Pt Conservative Rx
48
25
62
3 0
9
Total Dead

5. Total
Dead
0
50
100
150
Admitted Pt Male Female
141
80
6114 7
Mortality of July 2019
Total Dead
Mortality rate: 9.93%
7

6. Total
Dead
0
10
20
30
40
50
60
70
Emergency Opt Routine Opt Pt Conservative Rx
51
23
67
7
0
7
Total Dead

7. Cause of death
Name age
date of
admission
Time of
death
Diagnosis Cause of death
Md. Khalil
45years
28.05.19
2.06.2019
05.00 PM
Post surgical
complication due to
mesenteric vascular
occlusion
Direct cause: Septicemia
Underlying cause: Post surgical
complication due to mesenteric
vascular occlusion
Miss. Sonia
19 years
6.06.19
6.06.2019
04.00 PM
Jejunal perforation Direct cause: Septicemia
Underlying cause: jejunal perforation
Md.Mannan
70 years
7.06.19
8.6.2019
02.00 PM
Sigmoid colon
perforation
Direct cause: Septicemia
Underlying cause: sigmoid colon
perforation

8. Name age
date of
admission
Time of
death
Diagnosis Cause of death
Mr. Delwar
30 years
8.6.19
8.6.2019
06.00 PM
Perforation of gas
containing hollow viscus
with septic shock
Direct cause: septic shock
Underlying cause: perforation
of gas containing hollow viscus
Mr. Golam
Mostofa
60 years
29.5.19
10.6.2019
04.30 PM
Subacute intestinal
obstruction
Direct cause: Acute MI
Underlying cause: Subacute
intestinal obstruction
Mrs. Hazera
30 years
04.6.19
12.6.2019
12.00 AM
Intestinal obstruction due
to mesenteric vascular
occlusion
Direct cause: septicemia
Underlying cause: intestinal
obstruction mesenteric vascular
occlusion

9. Name age
date of
admission
Time of
death
Diagnosis Cause of death
Mis.Shafura
20 years
7.6.19
12.6.2019
02.00 PM
Illeal Perforation with AKI Direct cause: Renal failure
Underlying cause: Illeal
Perforation
Mrs.Josoda
65 years
15.6.19
15.6.2019
01.00 AM
Acute perforated calculus
cholecystitis with
empyema gall bladder
Direct cause: Septicemia
Underlying cause: Acute
perforated calculus cholecystitis
with empyema gall bladder
Mr.Md.Billal
65 years
11.6.19
16.6.2019
09.00 PM
CKD with HTN with LVF
with DM with COPD with
Prolapsed thrombosed
haemorrhoid
Direct cause: Multiorgan failure
Underlying cause: CKD with
HTN with DM with COPD with
Prolonged thrombosed
haemorrhoid

10. Name age
date of
admission
Time of
death
Diagnosis Cause of death
Mrs. Rube
50 years
1.6.19
21.6.2019
02.00 PM
Chronic cholecystitis with
DM
Direct cause: Acute MI
Mr.Kashem
70 years
1.6.19
18.6.2019
04.00 AM
Intestinal obstruction due
to volvulus of illeum
Direct cause: Septicemia
Underlying cause: intestinal
obstruction due volvulus of illeum
Mrs.Sokhina
55 years
24.6.19
26.6.2019
09.00 PM
Subacute intestinal
obstruction with
haemorrhagic stroke
Direct cause: Haemorrhagic Stroke

11. Name age
date of
admission
Time of
death
Diagnosis Cause of death
Mrs. Sheuli
36 years
9.7.19
9.7.2019
08.30 PM
Acute Calculas
Cholecystitis with CRF
Direct cause: ESRD
Underlying cause: Chronic renal
failure
Mrs anjona
Rani.
35 years
19.7.19
20.7.2019
08.30 AM
Gangrenous Sigmoid
Volvulus
Direct cause: Cardiac Arrest
Underlying cause: Gangrenous
Sigmoid Volvulus
Mrs.Jaeda
60years
23.7.19
25.7.2019
08.00 PM
Acute intestinal
Obstruction due to Ca
Rectosigmoid Junction
Direct cause: Aspiration Pneumonia
Underlying event: Acute intestinal
obstruction due to Carcinoma of
Rectosigmoid Junction

12. Name , age
, date of
admission
Time of
death
Diagnosis Cause of death
Mrs. Hawa
60 years
23.7.19
26.7.2019
06.30 PM
Carbuncle with
Uncontrolled DM
Direct cause: Diabetic Ketoacidosis
Underlying cause: Uncontrolled DM
Mrs.
Khadija, 60
years,
09.7.19
28.7.2019
08.30 AM
Advanced Carcinoma of
Stomach
Direct cause: Cardiac Arrest
Underlying cause: Advanced
Carcinoma of Stomach
Mrs. Mafia
55yrs,
30.7.19
31.7.2019
08.25 AM
Acute Intestintal
Obstruction with Septic
Shock
Direct cause: Irreversible Septic
Shock
Underlying event: Acute intestinal
obstruction

13. Name , age,
date of
admission
Time of
death
Diagnosis Cause of death
Mrs. Razia
55 years
30.7.19
31.7.2019
07.45 PM
Acute intestinal
obstruction due to illeal
volvulus
Direct cause: Septicaemia
Underlying cause: illeal perforation
Mr. Mohsin,
60 years,
21.5.19
09.7.2019
08.30 AM
Diabetic foot with CRF
with IHD with ischaemic
stroke
Direct cause: MI
Underlying cause: IHD, DM
Mr. Lalu
Das,55yrs,
09.7.19
10.7.2019
03.25 AM
Acute Pancreatitis with
HTN
Direct cause: Septicemia
Underlying event: Acute
Pancreatitis

14. Name , age,
date of
admission
Time of
death
Diagnosis Cause of death
Mr. Hasem
Ali
50 years
11.7.19
12.7.2019
07.00 PM
Advanced Carcinoma of
Stomach
Direct cause: electrolyte imbalance
Underlying cause: Advanced
Carcinoma of Stomach
Mr. Jakir,
45 years,
08.07.19
13.7.2019
08.05 PM
Acute intestinal
obstruction due to
mesenteric vascular
Occlusion
Direct cause: Septicaemia
Underlying condition: mesenteric
Vascular Occlusion
Mr. Chan
Mia 70yrs,
09.7.19
15.7.2019
07.25 PM
Carcinoma of Gallbladder Direct cause: Hepato-renal Shut
down
Underlying event: Carcinoma of
Gallbladder

15. Name age
date of
admission
Time of
death
Diagnosis Cause of death
Mr. Mir
Hossain, 52
years
2.7.19
16.7.2019
08.00 PM
Obstructive Jaundice due
to Periampullary
Carcinoma
Direct cause: Hepato-renal shut
down
Underlying cause: Periampullary
Carcinoma
Mr.
Nazmul, 84
years,
30.07.19
31.7.2019
3.05 AM
Extensive Cellulitis of rt
lower limb with Sepitc
Shock
Direct cause: Septic Shock
Underlying condition: Extensive
Cellulitis of Right lower limb

16. Case summary-01
Our patient Mr. khalil, 45 years old, hypertensive, non diabetic hailing
from Shibganj, Bogura admitted on the 1st POD of ileostomy following
resection and anastomosis of colon with the complaints of abdominal
pain, distention and non functioning ileostomy post operatively.
According to the statement of patient he was reasonably well 5 days
back. Then he developed generalized abdominal pain, which was
gradual in onset, persistent, aggravated by eating food, not relieved by
taking medication. He also complains of abdominal distention for same
duration

17. Case summary (cont’d..)
There was also no passage of stool and flatus for 5 days. With these
complaints he got admitted in kumudini medical college hospital
and underwent the above mentioned surgery due to diverticular
perforation of sigmoid and transverse colon with mesenteric tear
as mentioned in the discharge paper. Day following surgery his
condition deteriorated. Then he admitted in DMCH for better
management.

18. Cont’d..
On general examination, patient was
- ill looking, pale , pulse 132b/min, BP 80/60mm hg, R/R 22 beat/min
On per abdominal examination
- abdomen was distended with gauze bandage in situ in the mid line
with ileostomy in right side and a drain tube in left side
Ileostomy: gangrenous, non functioning
Bowel sound: absent
DRE Findings: normal
Others systemic examination revealed normal findings.

19. We resuscitated the patient and planned
for a relaparotomy

20. Investigation profile
• CBC : Hb –9.9gm/dl, TC – 11,000/cmm,
DC – N-84.3%
• S. Electrolytes : K+ 3.05 mmol/L, Cl- 107 mmol/L
Na+ -139 mmol/L
• S. creatinine : 1.066mg/dl
• S. albumin : 3.04 g/dl
• FBS : 4.3 mmol/L

21. Cont’d..
• HBsAg and anti HCV :negative
• ECG :sinus rhythm
• CXR :normal
• USG of W/A :Features suggestive of
intestinal obstruction

22. Operation note
Date : 29.5.2019
Time : 11.00AM-1.30PM
Indication : Sigmoid and transverse colon diverticular
perforation with mesenteric tear with
mesenteric vascular occlusion with ileostomy in
situ
Name of operation : Re laparotomy
Type of anaesthesia : G/A
Incision : midline incision

23. Cont’d..
• Procedure and findings:
• With all aseptic precaution abdomen was opened by previous
laparotomy wound. The whole small gut was gangrenous
proximally up to 5 cm of duodenojejunal junction and 2 cm of
ileocaecal junction due to mesenteric vascular occlusion. The
mesenteric vessels were secured and gangrenous small gut
was resected. The distal loop was closed and proximal one was
exteriorized with 16 Fr Foley’s catheter. Proper peritoneal
toileting was done. Then the midline wound and ileostomy
wound was closed with a drain tube in situ in pelvis.

24. Post operative follow up
• Patient was sent to post operative room in intubated state at
1:30 PM
• Pulse -88 beats/min
• BP -110/70 mmHg
• Respiratory rate -20 breaths/min
• Urine output -50 ml/hr

25. Follow up on 30.5.19
• 1st POD
• Patient was sent to male surgery ward
• Subjective :semi conscious
• Objective :pulse-102b/min
• :BP-100/60mmHg
• :Temp-99 F
:R/R-23br/min
:Anaemia- mild
:Dehydration-abscent

26. Cont’d..
Lung :Clear
P/A/E -Abdomen tense, tender, bandage dry
-bowel sound-absent
Drain -800 ml; intestinal content
NG Tube-200ml; bile stained
U/O -1000ml

27. Post operative investigation(30.05.19)
• Hb -9g/dl
• Total WBC -1800/cmm
• Neutrophil :96%
• Platelet -180,000/cmm
• S creatinine -2.01mg/dl
• S albumin -2.57g/dl
• S electrolyte -Na+ 125mmol/l
-K+ 2.05mmol/l
-Cl- 98mmol/l
We gave blood transfusion and taken measures to
correct electrolyte imbalance

28. Follow up on 02.6.19 @7.00 AM
Patient became very toxic with difficulties in respiration
On examination
Pulse -feeble
BP -80/50mmhg
R/R -24br/min
Temp -raised

29. Follow up @7.25 AM
• Pulse -Absent
• BP -Non recordable
• Respiration -Absent
• Pupil -bilaterally fixed, dialated and non reacting to
light

30. Cause of death
Septicemia

31. Analysis from chair
and
participants
○ Human factors
○ System factors
○ Patient factors