A remote death following Whipple procedure with significant Forensic pathological dilemmas
- Forensic Research & Criminology International Journal
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Ariyarathna HTDW, Hulathduwa SR
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