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Passed away due to sepsis leading to respiratory failure. Small intestine infected after surgery. Suggestions?

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General Surgeon
Practicing since : 1979
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My mother(81) passed away in September 2011 due acquiring sepsis leading to respiratory failure due to her lungs being infected after surgery on her small intestine.
Leading up to her hospital stay in September 2011 she had been having intestinal issues, sudden nausea, sometimes diarrhea with many of these episodes causing her to have a rapid heart rate(atrial fibrillation)
Even after over a year or more of several visits to her primary care doctor, heart doctor and emergency room they were unable to diagnose the underlying issue. On her 3rd ER visit within a 2 week period they decided to do a scan of her abdomen and determined she had a partially blocked small intestine – possibly due to scar tissue from hysterectomy 25 or so years earlier.
She was admitted to the hospital on a Friday night and an NG tube was placed to help relieved pressure on her stomach/digestive system. She was in terrible pain this entire time – her stomach remained flat the first full day(Saturday) on Sunday there was noticeable bloating in the abdomen. She still had the NG tube, but never passed any gas or stool. She did throw up one time even with NG tube in.
We did not realize the Surgeon and Gastroenterologist had discussed surgery on Sunday – however when we were told she would be scheduled for surgery Tuesday at Noon – the gastroenterologist told my brother he had felt the surgery should have been done on Sunday but he was out voted. By the way this is a medium size local hospital and it seems everything stops on the weekends even in a case like this a possible life or death situation.
The surgery was done on Tuesday – the surgeon came out in not much over one hour and told us things went well, there was some discoloration of the intestine and that small section was removed. We were later told my mother had to be placed on a vent and the intent was to remove it the next morning and it was. She was alert and talking not in pain as she had been and seemed to be on her way to recovery. They did keep her on oxygen via the nose.
Thursday 2 days after surgery she sat up in the bed and held her chest and told my father she could not breathe. She was then put on a full face oxygen and then eventually back on the vent. To make a long story short – my mother had sepsis, she eventually ended up with pneumonia and passed away 2 ½ days after having her moved to a larger more equipped hospital. 18 days total in both hospitals.
Several things concern me and my family after this ordeal and here 1 ½ years later we are still thinking something was just not right about all of this. Here are some of our major concerns and we would like a Doctors opinion to see if we should just let it go, or no you have some legitimate concerns about the quality of care your mother received.

Just the fact this was not diagnosed earlier until it really turned into an emergency and even then it was not treated as such.
Was this really a partial blockage or should the surgery have been done as soon as possible – not sure how it is considered partial when nothing was coming out of her except via the NG tube. Also the fact she was in terrible pain up until the time of surgery, even with pain meds. At half her age I don’t think I could have tolerated the pain she endured. Also the fact that part of her intestine had to be removed due to noticeable discoloration. Her heart doctor had given the okay for surgery early on if it was needed.
Another major concern is this hospital fought us every step of the way in having our mother moved to another facility – she was not moved until someone from the Medicare office called to tell them they had no choice. It was still another day and ½ before it happened – 2 ½ days before she passed away.
Other issues – NG tube – came in one day and this tube was lying on the floor(fluid on the floor) under my mother’s bed the other end still in my mother’s nose. One day my brother notice bubbles coming out of my mother’s nostril where NG tube was and the nurse checked and the tube was just inside her nose – we have no idea how long it had not been in her stomach. We assume it had been like this since the day we questioned how the tube had been in one nostril the entire time and then one morning we came in and it was in the other – the nurses nor doctors had any record of it being moved. There were several other NG tube issues, and if my mother’s life depended on proper operation of this tube she was doomed from the start.
All in all this was a nightmare – but of course my mother faired the worse – as she did not survive.
I would appreciate any input from any doctor and what their opinion or feelings would be if this were their mother.

Thank you very much -
Posted Sun, 30 Jun 2013 in Digestion and Bowels
Answered by Dr. M Y Shareef 1 hour later
Hi Mr XXXXX! I am Dr Shareef, a general surgeon answering to your query.
At first let me express my deepest condolences for your mother and I pray God to give you enough strength and patience to accept this truth.
As a matter of fact, your query can be answered best by the doctors who treated your mother as they physically examined her right from the start. However, you may note the following points on the illness of your mother :
1) As she was suffering for more than a year, the obstruction in her intestines must be partial to start with which was getting blocked completely, but intermittently, causing pain, nausea and vomiting at that time . She was getting relieved whenever the obstruction got relieved and that is why it is called partial or sub acute intestinal obstruction. Atrial fibrillation possibly was an independent entity in addition to the partial obstruction of intestines.
2) Your mother got relief and her abdomen became flat on the day of inserting the NG tube, but the next day again it got distended. This could happen at times due blockage of the NG tube by some gastric particles or due to any displacement of the NG tube, which might have been taken care of by the hospital staff
3) If she had severe pain abdomen with distension and vomiting, that indicates that the obstruction became complete, and that is an emergency situation needing urgent surgery once diagnosed in the hospital.
4) If the intestines which was removed due to discoloration , that suggests that it was gangrenous because of lack of blood supply to the part , and this can happen if the obstruction due to a band or adhesion or whatever reason is not released urgently.
5) Post operative infection and sepsis can occur at any place following such kind of major operation(resection and anastomosis).
After opining as above, I still insist that the doctors treating your mother are the best judge of the prevailing conditions during the period, as clinical bed side judgement is always in the best interest of the patient.
I hope I have provided you with the information you needed.If there is any further query, you can post it without any hesitation. Take care.
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