You are on page 1of 2

1. Court of inquiry, being held to probe into the circumstances under which wife of Mr.

Mukhtar Ali Rana, Pl. No. 753707, stenographer, admitted in POF Hospital on 11 th
September 2016, later on died on 17-09-2016 in hospital.

My comments as HOD Surgery are as follow

i. Patient was admitted at 4 pm, 11/09/2016 with presenting complaint of acute pain
abdomen and vomiting. On physical examination abdomen was very tender and
guarding was positive. Clinically the case was of acute abdomen seen by PGT Dr.
Huda.
ii. Patient was kept in ITC and necessary investigation from laboratory and radiology
were requested. At 8 pm was seen by Dr. Kamran Afzal, Senior PGT and registrar.
iii. Conservative line of treatment was followed, with good results i.e. abdominal pain
was relieved, Nasogastric tube was removed and oral fluids were allowed, after the
patient started passing stool. On 12-09-16, patient was seen by PGT surgery, PGT
anaesthesia and consultant anaesthetist Dr. Rashida Farooqi and Brig. Imran.
iv. Patient was shifted from ITC to Female Surgical ward on 13-09-2016 by Dr. Azhar
Assistant Professor Surgery..
v. On 16-09-16 patient was seen by me in Female Surgical ward on morning round,
patient was complaining of lower abdominal pain and passing loose motion.
Ultrasound Abdomen had been done thrice, which showed Cholelithiasis and
moderate ascites. (Page No. 37, 39 and 51)
X-Ray plain abdomen and X-Ray erect chest were done. Surgical doctors
were not able to pick pneumoperitoneum, which was mild and on left
hemidiaphragm, superimposed to stomach air bubble. (Retrospective report;
page No. 50)
vi. With provisional diagnosis of intraperitoneal collection/ adhesions/ pelvic abscess.
Laprotomy was planned and CT scan abdomen was advised.
vii. Patient was up and about, passing stool and was able to drink. 1.5 liters of normal
saline, mixed with oral contrast.
viii. Just after CT scan with I/V contrast at 2 pm on 17-09-16, patient has all the features
of anaphylactic shock, was shifted to ITC. Pulse 130-160/min, B.P; 117/80 mm of Hg
and pO2 of 86%.
ix. In ITC, patient was seen by PGT surgery Dr. Huda and was consulted with Dr.
Naveed Ashfaq. Patient was also attended by Brig. Imran FCPS, HOD Anaesthesia
resuscitated but could not be saved and patient expired in ITC at 1710 Hrs.
In my opinion, the patient had perforation of intestine at the time of admission.
Although immediately X-ray plain abdomen and ultrasound abdomen was done, the
crucial finding of gas under diaphragm was missed, both by treating surgical team
and radiologist who concentrated on gall stone (which was not seen in CT scan).
Patient was rightly kept in ITC and guideline for conservative treatment of acute
abdomen (perforated duodenal ulcer/ acute pancreatitis/ Enteric perforation) were
followed, leading to good outcome and shifting the patient to female surgical ward.
From 11th September 2016 to 15th September 2016 were Eid holidays. During her stay
in ITC/FSW patient was regularly seen by PGT on duty, Senior on call (Dr.
Muhammad Azhar; Assistant Prof. WMC), MO with 4 years training in surgery (Dr.
Muhammad Kamran Afzal).
Out of 4 Eid holidays, Dr. Naveed Ashfaq, Assistant Prof. WMC was surgeon-on-call
for 03 days. During all these days PGTs were in regular contact with him.
Although the important finding of Gas under the diaphragm was missed, the patient
responded well to conservative treatment guidelines.
Considering the cause of death of patient, it is clear from the case record that she was
walking, passing stool and taking orally when she was sent for CT scan abdomen but
after CT scan with I/V and oral contrast she had all the feature of acute anaphylactic
shock and was managed accordingly. She was also a known case of allergic bronchial
asthma.
My opinion of acute anaphylactic shock of I/V contrast is further supported by eight
similar cases reported from other wards, leading to two more deaths in 2-3 weeks
time. Another court of inquiry to find out the reason of repeated anaphylactic reaction
to I/V contrast was held. It was headed by Prof. Dr. M.A. Nasir Malik HOD Surgery,
Dr. Salik Mehmood Senior MO, report was submitted to Commandant POF Hospital
that court of inquiry report must be made a part of this court of inquiry.