Mortality and Morbidity Meeting

Name: Pannirselvam A/L M Nagam

MRN: 1618630
AGE:58
DOA:10/2/2022
PRONOUNCED DEATH:10/3/2022
CAUSE OF DEATH: Septic shock secondary to multiple organ failure

MORTALITY AND MORBIDITY REPORTING FORM

Department of Surgery,
Hospital Selayang

CAUSE OF DEATH: Septic shock secondary to multiple organ failure

Pannirselvam A/L M Nagam,58 years old Indian Gentleman, with underlying upper rectal carcinoma, did
Laparoscopic Anterior Resection on 28/1/2022 at Hospital Selayang.
The patient presented to ED on post-operation Day 13th with a chief complaint of sudden onset of abdominal
pain for 1 day, fever for 5 days and reduced oral intake.

Upon examination, the patient was alert, septic looking, had laboured breathing, tachypnea with a respiratory rate
of 30 breaths per minute. The abdomen was soft, not distended, and tender over epigastric and left
hypochondriac. Per rectal examination, posterior half of anastamosis defect.Dil issued.

The case was posted for urgent exploratory laparotomy, dismantle anastomosis, colostomy, washout with
primary bladder repair for anastomotic leak post lower anterior resection secondary to ischemic proximal conduit
completed on 10/2/2022 at 0820H.Intraoperative finding Frank pus about 1.2 L intraperitoneal in all quadrant
with slough, ischemic bowel segment at the anastomotic area(proximal conduit) and distal 3 cm rectal stump
closed.

Post-operation, the patient was intubated for 13 days. Nephro team was on board for severe metabolic acidosis
for dialysis. Inflammatory marker noted increasing in trend. Blood culture was sent noted ESBL Ecoli and
enterococcus raffinosus bacteremia under ID team management and started IV Linozide. Subsequently, he was
able to wean down to VM. However, the patient was reintubated the next day due to impending cardiorespiratory
collapse, noted
bleeding from the operation site, central venous line and double-lumen site. Hb drops to 6.8, homeostasis
suturing done. Uro team was referred for hematuria and treated conservatively. OS team was on board for
intraoral bleeding at the right buccal mucosa. Bedside OGDS was done, Noted tear at z-line (distal oesophagus)
likely due to ryles tube. Injected adrenaline 1cc x 5. Visible vessel just above that - clipped x 1.

On post-operation D25, the patient further deteriorated with minimal urine output,5cc/hr. Introduction to ceiling
therapy to the family by anaes team. The patient was extremely ill for the past 3 days, family members agreed
not to escalate further treatment and more keen on comfort care.

On 10/3/2022 0255 patient succumbed and was pronounced dead.

Comments by Coordinator/Head of Department

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House Officer On Duty

DR NG MEI YEE

Medical Officer On Duty

DR FARAH G

Specialist On Duty
MR SYED