Abstract

Whipple  procedure  is  a  major  surgical  operation  to  remove  the  head  of  the  pancreas,  duodenum, gallbladder and the bile ducts most commonly performed for malignant tumors involving the head of the pancreas and distal bile ducts. It is also performed following pancreatic  or  duodenal  trauma  as  well  as  chronic  pancreatitis.  The  outcome  depends  on  numerous factors. There are few recognized complications among which sepsis stands out prominently. The deceased in this case discussion had undergone Whipple procedure within three months after the onset of initial cluster of symptoms. Abdominal pain had been the most prominent symptom he presented with. The surgery was uneventful. The patient had been  discharged  on  the  8th day following surgery. He had been advised to get the wound dressed every other day and visit the clinicin regularintervals. The deceased had not fully complied with the instructions and after observing a purulent discharge from the skin wound, a wound debridement had been done around the fourteenth day post op. The condition had gradually  deteriorated  since  then  and  the  deceased  was  re-admitted  to  the  same  ward  on  the eighteenth day following the surgery where he succumbed to death due to sepsis with metabolic acidosis. A judicial autopsy was performed following an inquest to exclude any possible allegations of medical negligence. Mild icterus was noted on external examination. Macroscopic  features  of  sepsis  with  surgical  site  infection  and  generalized  peritonitis  were  observed  during  dissection.  Pancreaticojejunal,  hepaticojejunal,  gastrojejunal  and  jejunojejunal anastomosing sites were free of features suggestive of leakage. The cause of death was finalized according to the WHO guidelines.

Keywords

epsis, surgical site infection (classification), Whipple procedure, cholangiocarcinoma