Indexing Title: CLEYSONs Medical Anecdotal Report [04-5]

MAR Title:  A Life for A Better Surgeon

Date of Medical Observation: August 8, 2004

 Narration:                               

On August 6, 2004, I was decked to operate on a 47-year-old male with symptomatic cholecystolithiasis with the assistance of our team captain.

Intra-operatively, the gallbladder was six by two centimeter with thin walls and contained three black stones, common bile duct and cystic duct were not dilated. We noted adhesions at the antral area of the stomach but we decided to leave it alone.

On the second post-operative day, I received a phone call from one of my senior resident informing me that my patient developed abdominal distention, had episodes of hypotension. At that moment, he was at the radiology department for a plain abdominal film. Surgical abdomen was entertained.

Without second thought I went to the hospital and examined the patient myself and I agreed with their findings.
I informed my team captain of the patient’s condition and he told me to refer the patient to our consultant and that he was on his way to the hospital.

We directed the patient to the operating room for exploration.
There was generalized peritonitis and a 1.5 cm gastric perforation discovered at the area where we noted the adhesion from the previous operation.
A primary repair with graham patching was done. However on August 10, 2004 the patient succumbed to sepsis and expired.

Insights (DISCOVERY, stimulus, REINFORCEMENT)

As I reflected on the situation, I realized that I failed to elicit a past medical condition that was very essential to the management of this particular patient. He was previously diagnosed and treated for a gastric ulcer with H. pylori infection.

The circumstances made me realize that I have been giving less attention in extracting the past medical condition of those patients who seek medical/surgical attention.

I should focus not only to the current surgical problem of a patient but also give attention to the small details in the history and physical examination especially if it will affect my intervention.

During the morbidity and mortality presentation, I have discovered that the biggest mistake that I have done was leaving that suspicious intra-operative finding alone.

I should have explored the area for anything that might have caused that adhesion.

It was pointed out then that any uncertain finding should be scrutinized.

It is a shame that sometimes a life should be taken from us to learn how to become a better surgeon.