Dad died of multiple organ dysfunctions post-Whipple. Cause?

Question

Hi doctor,

This query is regarding my dad, who was diagnosed with obstructive jaundice last year. He was admitted to a hospital, and the doctor examined my dad and told us that they need to perform a Whipple procedure on my dad. We did not ask for a second opinion, and we let them go ahead with the surgery. The operation took 13 hours, and he was hospitalized for 41 days after the surgery. He was finally discharged after 41 days, but he was suffering from stomachaches, arms pain, and fever. The biopsy report showed stage 1 pancreatic cancer, and the oncology doctor told us that chemotherapy is not required. He just told us that CA-19-9 test needs to be done every three months, for five years. My dad recovered, and he was on a normal diet.

Last month, my dad started complaining about stomach pain, so we admitted him to the hospital again. After an endoscopy and CT scan, the doctor told us that there was some infection in the operated area and that antibiotics will cure it, and my dad will be released in two days. After two days, the doctor told that the infection was still there, so they need to admit him for two more days. But after four days, my dad started having a fever, vomiting, and shivering. So, the doctor changed his antibiotics and admitted him for three more days. We requested him to refer him to another hospital, but he said that he could handle my dad's case, and told us not to worry. On the tenth day, my dad was shifted to the ICU. My dad's nails and tongue changed to dark blue color, and the doctor told us that it was due to less blood flow. My dad was bleeding in the urinary tube, so we shifted him to the hospital where the Whipple was performed. Then my dad was again admitted to the ICU, and the doctors put him on a ventilator and other life supporting devices. The doctors informed us that he was suffering from multiple organs dysfunction. And the next day morning my dad passed away. I have enclosed CT, MRI, and other lab reports. How did my father die? What caused his death? Please help me. Thanks

Answer 1

Hi,

Welcome to icliniq.com.

I have carefully gone through all your dad's reports (attachment removed to protect patient identity).

First of all, I am sorry for your loss. I also feel saddened by your story as it could have been managed so much better. Consider it a help to just guide you regarding what went wrong and how things could have been prevented.

After the surgery, Whipple procedure that the patient underwent, he developed a complication, namely pancreatic leak, this could have, but not definite, contributed to the formation of stricture or narrowing of the connection between the bile passage and intestine.

This complication of the pancreatic leak is not very common these days, but still, it happens in around 15 % of patients. It was documented by the surgeon and managed conservatively. It is not that all pancreatic leak patients will develop strictures, but the risk increases around four times.

Due to this stricture, there was obstruction of the bile flow from the liver to the intestine. Stagnant bile gets infected very easily and that is what happened in your father's case.

To remove the infection, the narrowed passage should have been cleared by putting a pipe or tube into the system to drain it and then like doing an angioplasty, dilating it with a balloon to widen the passage. This could have been done only radiologically in this case.

This, in my opinion, was the crucial mistake that your dad's gastroenterologist made. He did not get the drainage done in time. I do not know the reason for this decision from the records provided. This infection spread out of control, especially, since your father was a diabetic patient. By the time you were sent to the surgeon, it was already too late. This was the second mistake.

Hope that explains it for you.

For more information consult a medical gastroenterologist online.