Missed sepsis post-laparoscopic cholecystectomy – Case 290
A patient was readmitted for pain control five days after a difficult elective laparoscopic cholecystectomy. Ultrasound was difficult because of patient habitus, but unremarkable. On the following morning the patient still had a tender abdomen and guarding, but no rebound, with normal bowel sounds. Blood pressure and pulse were normal. Blood tests revealed an inflammatory response and after consultant review the plan was for supportive therapy and repeat assessment over the weekend. The patient was handed over to the night on-call team for review. On the following morning, a Saturday, the night registrar noted the patient wasn’t on the list for ward review (in that hospital, inpatients are placed on a different list from post-take patients and are reviewed by a separate surgical team) and the FY1 was informed. The FY1 did not include the patient on his list and therefore the patient was not reviewed that day by the FY1 nor the locum registrar who was covering the wards. The ward nurses responsible for the patient did not alert the surgical team to the fact that that the patient had not been seen. On the Sunday morning, the night on-call registrar, who knew the patient, reviewed all the blood tests from the Saturday and noted a soaring inflammatory response. The surgical team went to review the patient at that point and found her to be septic and with frank peritonitis. The patient underwent urgent surgical exploration during which a subhepatic collection of old blood, bile and fibrin was washed out, and a drain placed. The patient eventually made a good recovery.
