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Death due to acquiring sepsis leading to respiratory failure due to lungs being infected after surgery on small intestine. Suggestions?

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Dr. Grzegorz Stanko

General Surgeon

Practicing since :2008

Answered : 5770 Questions

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Posted on Tue, 25 Jun 2013 in General Health
Question: 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 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 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 with the exception of the NG tube. Also the fact she was in terrible pain up until the time of surgery. 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 -
doctor
Answered by Dr. Grzegorz Stanko 2 hours later
Hello!

Thank you for the query.

Accelerated heart rate were most likely caused by bowels obstruction, nausea and diarrhea. Heart accelerates with every inflammatory process and with every dehydration. So your mother during this visits before hospital admittance has probably developed kidneys failure (due to dehydration) and infection (even sepsis could be present). It should be easily diagnosed with physical examination and blood work (WBC and CRP should be elevated, creatinine increased). Symptoms described by you are quite characteristic for bowels obstruction. And it seems that the obstruction were complete not partial. Stool can be present for some time even with bowels obstruction. Gas gets blocked first.

As it took 2 weeks to diagnose her, surgery should be done right after the diagnose. Intestine discoloration indicates its ischemia and necrosis what is a potential source of SEPSIS. I`m pretty sure they have done some blood work. There must have been something in it. Especially with 2 weeks lasting obstruction. So emergency surgery were necessary.

As your mother were in advanced age and had surgery done too late, after the surgery she should be admitted to ICU (intensive care unit). This would give her some chances to live. Most likely she has also developed pneumonia due to aspirating vomits (it is called Mendelsons syndrome).

NG tube is necessary with bowels obstruction to prevent pneumonia. It is hard to tell what was done with it. There is always a risk of inserting it to the lungs. Some patients can remove it by itself as this is very uncomfortable.
What is certain, property inserted NG tube before the surgery could prevent your mother from pneumonia.

Please dont treat it as a 100% accurate answer. I havent been there, did not see any results and did not examine your mother. So I can only suppose.

Hope you will find it helpful. Feel free to ask further questions.
Regards.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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