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Gastroenterology (Expert Forum)
ERCP
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ERCP
by debbrown, Jun 25, 2002 12:00AM
I have so many questions and don't know where to start.
Last month, my mother went into the hospital for an ERCP which was to look for gallstones and then 2 days later to do the gallstone operation.
The ERCP was performed at 5:00pm on May/20, by 8:15, she was violently vomitting bilous green fluid with pain and distended abdomen. By Tuesday am, she was in severe pain and further distension of abdomen. On Wednesday, they performed scheduled gallstone operation to find ischemiac bowel and pancreatitis. Condition further detoriated and laparotomy was again done during which subtotal colectomy was done in addl to removel of the terminal ileum. Further detoriation until 3 days after inital ERCP, death occurred.
Damage done:
- Lungs - severe congestion and oedema
- Liver - coated by acute inflammatory exudate
- Thryoid - severe lymphocytic infiltration
- Spleen - severe congestion
- Pancreas - extensive haemorrhagic infraction both the surface and substance of the organ. A number of thrombooccluded vessels
- Omentum - patchy areas of haemorrhagic necrosis
- Gallbladder - sections show extensive necrosis of the mucosal folds. Severe Haemorrhagic infraction and necrosis extending to the surface.
- Stomach / Intestines / Urinary bladder - show haemorrhagic infarction with moderate congesion
Could acute pancreatitis do this much damage in 2 days; if not, what could?
Last month, my mother went into the hospital for an ERCP which was to look for gallstones and then 2 days later to do the gallstone operation.
The ERCP was performed at 5:00pm on May/20, by 8:15, she was violently vomitting bilous green fluid with pain and distended abdomen. By Tuesday am, she was in severe pain and further distension of abdomen. On Wednesday, they performed scheduled gallstone operation to find ischemiac bowel and pancreatitis. Condition further detoriated and laparotomy was again done during which subtotal colectomy was done in addl to removel of the terminal ileum. Further detoriation until 3 days after inital ERCP, death occurred.
Damage done:
- Lungs - severe congestion and oedema
- Liver - coated by acute inflammatory exudate
- Thryoid - severe lymphocytic infiltration
- Spleen - severe congestion
- Pancreas - extensive haemorrhagic infraction both the surface and substance of the organ. A number of thrombooccluded vessels
- Omentum - patchy areas of haemorrhagic necrosis
- Gallbladder - sections show extensive necrosis of the mucosal folds. Severe Haemorrhagic infraction and necrosis extending to the surface.
- Stomach / Intestines / Urinary bladder - show haemorrhagic infarction with moderate congesion
Could acute pancreatitis do this much damage in 2 days; if not, what could?
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Severe pancreatitis is often associated with a marked increase in microvascular permeability, leading to large volume losses of intravascular fluid into the tissues, thereby decreasing perfusion of the lungs, kidneys, and other organs. Probably the single most important element in preventing multiple organ failure is vigorous fluid resuscitation with electrolyte solutions in order to optimize cardiac index and maintain hemodynamic stability. Swan-Ganz monitoring is helpful in such patients. In this scenario, fewer patients develop multiple organ failure. Patients with severe pancreatitis should be treated in an intensive care unit because of the associated high mortality and morbidity rates.
How about this? As well as a reference to faecal fluid in the abdominal cavity when they did the second ERCP about 36 hours later (about 10am on May/23) when they did the NG (Naso Gastric tube) in ICU later on that same day there was definitely evidence of "lots" of fecal matter; could they have done duodenal perforation during ERCP, which when further undiagnosed,
and untreated within 16-41 hours caused full blown sepsis, perotinitis and subsequently renal failure, necrosis, gangrene, eschemic bowel, kidney failure and within further 39 hours multiple organ failure and death.
Thanks
Secondly, anything could of happened and yes, infection could set in and this is with any procedure.
My sister lost a good friend having a simple knee procedure last month. She developed a fulminating infection and everything shut down and she died within 4-5 days of this procedure.
Deb, did they do an autopsy to determine just what happened and if not, why not?
My prayers are with you and your family.
I am so sorry for your loss. My thoughts are with you at this time.
Taylee
- Soccermom