How death may occur during surgery–part II
A 34-year-old woman noticed that the pattern of her menstrual period had changed over time.
She was having prolonged and heavy flow of blood and often felt weak and unable to carry on with her normal exercises during those days. She was directed to see a gynecologist who examined her and found that she was lacking blood and had an enlarged uterus.
The gynecologist sent her for an ultrasound examination of the uterus which confirmed that she had uterine fibroids. The doctor then explained to her that the fibroids were most likely responsible for the heavy period which in turn led to the anaemia.
The doctor then gave her various treatment options ranging from conservative management (giving her drugs to build up her blood and also gradually reduce the size of the fibroid) to surgery. The patient opted for surgery but was worried about the scar on her abdomen.
Laparoscopic surgery
The doctor explained to her that there was a new technique called laparoscopic surgery that would hardly leave her with a scar but informed her that it was a rather expensive procedure which was only being performed in very few centres in the country. She opted for that surgery. She was then referred to the appropriate centre.
The woman was admitted to the hospital an hour or so to the surgery. She was accompanied by a relative. A doctor had been flown in specially to carry out the operation. The patient was examined before the operation and found to be fit for the surgery. She was then taken to theatre and the operation commenced.
However, shortly after the patient was taken for the operation, one of the doctors attending to them informed her relative that she had died. A postmortem examination was requested for.
Two pathologists were asked to carry out the postmortem examination. The pathologists found that a small surgical incision was in the abdomen of the patient and there was some bruising of the internal organs. The pathologists also found that there was some blood in the stomach of the patient. The surgeons, in the request for the postmortem, had indicated that the patient’s heart had slowed down before she died.
What went wrong?
There was only one logical explanation as to how the death of the patient occurred. That the patient died at the beginning of the operation was not in doubt. The operation was to remove a fibroid; the pathologists found one big fibroid in the wall of the uterus. The uterus and the fibroid had not been operated upon.
The patient had been examined before the operation. She had no other complaint. It was, therefore, unlikely that she had blood in her stomach before the operation.
It is therefore more than likely that at the start of the operation, the tube used to administer oxygen and the anesthetic drug must have been inserted into the patient’s esophagus instead of her trachea. This caused the stomach walls to bleed as the oxygen and the anesthetic agent caused distention and irritation of the stomach walls.
And the lack of oxygen and anesthesia compounded the patient’s condition. This is what explained the slowing down of the patient’s heart.
The patient’s doctor and the anesthetist were charged before court for causing the death of the patient by rash and negligent act.
The particulars of the charge were that the two failed to ensure that endo-tracheal tube which was supposed to supply oxygen and anesthesia to the lungs of the patient had been properly inserted into her trachea before embarking on a laparoscopic surgery thereby leading to the patient’s death.
To be continued
