PC 58yo male that died after having had a Whipple procedure to address a diagnosis of pancreatic adenocarcinoma on December 6, 2023.
After PC’s surgery it was reported to the family that the surgery was successful, and that the tumor and several lymph nodes had been removed, and that clear margins were obtained. PC was clinically and hemodynamically stable post-surgery. He was alert and ambulatory. PC was transitioned to a clear liquid diet the next morning.
December 7th evening (approx 730pm), slowly begins to have hypotension, tachycardia and lethargy. On December 8 (approx 3am) treated with labs, fluid bolus and was upgraded to ICU for closer observation. 1 hour later, has a cardiac arrest event with down time approx. 9 minutes. There is concern for an aspiration event. When the NG tube was placed, 2 L of bilious gastric content was removed. They also aspirated a significant amount of fluid from his lungs. Lab work during this time did reveal a lactic acid above 8 but no other significant change. PCs abdomen noted to be increasingly and diffusely distended and swollen. CT scans revealed bilateral significant lung consolidations with small amount of free air in fluid in the pancreatectomy bed. Mild thickening of the CBD wall and severe bladder wall thickening. Due to this persistent hypoxic failure, surgeons elected to treat with ECMO and he was cannulated later that afternoon. They also initiated CRRT due to severe metabolic acidosis and renal failure with no urine output.
PC continued to decline the next day (Dec 9) and was maxed out on pressures. They diagnosed him with abdominal compartment syndrome and perform a bedside decompressive laparotomy with ABertha wound vac. No significant findings. (Lactic acid continues to climb to over 14 despite ABX, etc)
Dec 10: PC continues to decline and elect to have exploratory laparotomy which reveals no acute ischemia or active bleeding however the liver is noted to be very dark and discolored and theorized to be the source of the acidosis. Consensus among providers agree that the “severe metabolic arrangement” is not reversible and PC is continually declining. Family makes PC DNR and unfortunately the PC passes away in the late afternoon of December 10th.
The records concerning this hospitalization are vast, however I did attach screenshots of the original Whipple procedure and final diagnosis/amended findings of the autopsy.
We take an opinion concerning the original surgery and any subsequent treatment plans up until PC death. PC was recently retired and had no significant medical history prior to pancreatic cancer diagnosis a month prior to this admission.
We think in advance for your opinion and your time. Would be happy to answer any clarifying questions.
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