Mortality

1. Mortality Meet: April 2023
Presenter,/ : Dr Preeti Kumari Gond
Moderator : Dr S K Sahu
Co-moderator : Dr S M Ali

2. Statistics for month of April
• Total number of admissions :
• Total number of elective surgeries : 83
• Total number of emergency surgeries : 42
• Total number of minor OT cases : 90
• Total number of mortality : 6

3. Case description
Name : Mamata Moharana
Age/sex: 38/ female
Presenting complaint: generalized pain in abdomen and distension for 3
days
co-morbidities : K/C/O T2DM on OHA
Date of admission: 31/3/2023

4. Vitals
The patient was conscious, oriented
PR: 110/min
BP: 138/88 mm hg
RR: 18/min
SPO2: 98% in RA
Afebrile
Per abdomen : distended, no guarding or rigidity, bowel sound absent
DRE : no significant finding

5. Management
The patient was planned for emergency exploratory laparotomy in view
of acute intestinal obstruction
Intra –op findings :
• Growth at splenic flexure causing luminal narrowing
• Incompetent IC valve with generalized dilatation of small bowel till DJ
flexure.
Procedure : EL + left hemicolectomy + transverse end colostomy and
closure of distal stump

6. In hospital stay
The patient was extubated and shifted to the SICU
The patient shifted to SHDU on POD2 , stoma functional
Allowed orals from POD 3

7. POD3
Issues
1. Patient developed tachycardia and respiratory distress , and had
bilateral pleural effusion
2. Deranged liver function test
• Underwent therapeutic B/L pleural tap
• Gastroenterology consultation
• Cardiology consultation

8. POD 8
Issues :
1. Persistent tachycardia
2. Pleural effusion
3. Sepsis
4. SSI
Management
• Setup of antibiotics
• Nutritional built-up through oral diet

9. In hospital stay –POD9
Patient underwent
1. NCCT Abd, thorax, and pelvis
Mild ascites , B/L plural effusion
2D ECHO: normal study

10. POD9
Issues :
1. Blood c/s positive
2. Sepsis progressing

11. POD 18
Issues :
1. Stoma retraction and peristomal necrosis
2. Sepsis
Management
Patient planned for emergency re-exploration

12. Second surgery
Procedure: Exploratory laparotomy, dismantling of stoma with double
barrel transverse and descending colostomy
Intra-op finding :
• Dense adhesion between bowel loops
• Serosanguinous collection in the perihepatic region
• Purulent collection around splenic flexure with stump blowout
Patient extubated and shifted to HDU

13. POD2 (2nd surgery)
Issues :
1. Stoma not functional
2. Sepsis
3. Bilious output in the abdominal drain
Management
• Patient shifted to SICU
• NCCT with oral contrast
• Setup of antibiotics
• Inotropic started

14. POD4
Patient planned for re-exploration
Procedure : EL, resection of perforated ileal segment , end ileostomy
and distal mucus fistula
Intra –op findings :
• Densely adherent small and large bowel loops
• Purulent collection in the pelvic cavity
• Two perforations at 10 cm and 40 cm from IC junction.
Patient could not be extubated and shifted to SICU

15. POD1 ( 3rd surgery)
Issues :
1. Sepsis
2. MODS
Management :
• Patient was intubated and on double inotropic support
• Supportive treatment and parenteral nutrition started

16. POD2
Patient had an episode of bradycardia followed by cardiac arrest .
Could not be revived , and declared dead.

17. HPE report
Adenocarcinoma, poorly differentiated, grade 3. w/o LVI or perineural
invasion.

18. In hospital stay summary
• Patient was admitted on 31/3/23
• Operated on 31/3/23
• Underwent re-exploration on 19/4/23
• Underwent 3rd exploration on 22/4/23
• Expired on 24/3/23
• Total hospital stay: 24 days

19. Issues with the patient
• Co-morbidity: T2DM
• Poor general condition
• Malignancy
• Sepsis
• MODS

20. Pitfalls
• Stump blowout post 1st surgery
• Ileal perforation missed during second surgery

21. Thank you