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Thread: Lawmaker's death reminder of surgical risks

  1. #1
    Super Moderator cougarnurse's Avatar
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    Lawmaker's death reminder of surgical risks

    Yikes! Lawmaker's death a reminder of surgery risks - Yahoo! News

    Gallbladder surgery is usually a very safe operation, but a powerful congressman's death is a reminder of the known risks.

    Well over half a million people have their gallbladders removed annually, most of them minimally invasively just as the late Rep. John Murtha, D-Pa.

    Complications are rare. But they include nicking the intestine, liver or bile duct as doctors struggle to squeeze an inflamed gallbladder through a tiny opening in the abdomen. And if an intestine or bile duct is perforated, spotting it quickly can mean the difference between survival or death from massive infection.

    "Every hour we delay diagnosis, the chance of overwhelming sepsis goes up," said Dr. Kevin Olden, a gastroenterologist at Washington Hospital Center — who wasn't involved in the congressman's care at two nearby hospitals.

    Moreover, the risk of complications rises with age, and when doctors must remove what they call a "hot gallbladder," one already inflamed or diseased.

    In a younger person, a less diseased gallbladder is similar to a boiled egg, and can just slide out fairly easily, Olden said. But an older or sicker gallbladder more resembles a prune that has to be peeled off surrounding tissue, making removal a bigger challenge.

    Murtha, 77, was first hospitalized with gallbladder problems in mid-December at the National Naval Medical Center, and eventually had his gallbladder removed there. Then on Jan. 31, a few days later, he came to another hospital's emergency room with a fever and infection. The Virginia Hospital Center in Arlington, Va., said he died there Tuesday from "major complications from surgery" at the first hospital.

    His family is not revealing details, but a longtime friend, Rep. Bob Brady, D-Pa., has said Murtha's large intestine was damaged during the gallbladder removal, triggering the infection.

    It's most common to nick the bile duct that connects the gallbladder and liver. That can often be repaired with minimally invasive surgery, resealing it to stop leakage of bile and treating any infection with antibiotics.

    Nicking the liver seldom is life-threatening; it's a solid organ.

    Nicking the intestine is an especially rare event. A small hole sometimes will reseal on its own, and the intestine's folds can hide a perforation, leading to delayed diagnosis.

    But a perforation means bacterial-laden intestinal contents start leaking into the abdomen, which is supposed to be sterile, and can require open surgery both to fix the leak and to literally cleanse the abdominal cavity, Olden said.

    It's both a medical error and a known risk of surgery. "It should not happen, but sometimes, despite everyone's best efforts, it can happen," Olden said.

    Virginia Hospital Center has said only that Murtha received "aggressive critical care interventions."

    Any thoughts or comments?

  2. #2
    Ricu
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    Re: Lawmaker's death reminder of surgical risks

    Quote Originally Posted by cougarnurse View Post
    Yikes! Lawmaker's death a reminder of surgery risks - Yahoo! News

    Gallbladder surgery is usually a very safe operation, but a powerful congressman's death is a reminder of the known risks.

    Well over half a million people have their gallbladders removed annually, most of them minimally invasively just as the late Rep. John Murtha, D-Pa.

    Complications are rare. But they include nicking the intestine, liver or bile duct as doctors struggle to squeeze an inflamed gallbladder through a tiny opening in the abdomen. And if an intestine or bile duct is perforated, spotting it quickly can mean the difference between survival or death from massive infection.

    "Every hour we delay diagnosis, the chance of overwhelming sepsis goes up," said Dr. Kevin Olden, a gastroenterologist at Washington Hospital Center — who wasn't involved in the congressman's care at two nearby hospitals.

    Moreover, the risk of complications rises with age, and when doctors must remove what they call a "hot gallbladder," one already inflamed or diseased.

    In a younger person, a less diseased gallbladder is similar to a boiled egg, and can just slide out fairly easily, Olden said. But an older or sicker gallbladder more resembles a prune that has to be peeled off surrounding tissue, making removal a bigger challenge.

    Murtha, 77, was first hospitalized with gallbladder problems in mid-December at the National Naval Medical Center, and eventually had his gallbladder removed there. Then on Jan. 31, a few days later, he came to another hospital's emergency room with a fever and infection. The Virginia Hospital Center in Arlington, Va., said he died there Tuesday from "major complications from surgery" at the first hospital.

    His family is not revealing details, but a longtime friend, Rep. Bob Brady, D-Pa., has said Murtha's large intestine was damaged during the gallbladder removal, triggering the infection.

    It's most common to nick the bile duct that connects the gallbladder and liver. That can often be repaired with minimally invasive surgery, resealing it to stop leakage of bile and treating any infection with antibiotics.

    Nicking the liver seldom is life-threatening; it's a solid organ.

    Nicking the intestine is an especially rare event. A small hole sometimes will reseal on its own, and the intestine's folds can hide a perforation, leading to delayed diagnosis.

    But a perforation means bacterial-laden intestinal contents start leaking into the abdomen, which is supposed to be sterile, and can require open surgery both to fix the leak and to literally cleanse the abdominal cavity, Olden said.

    It's both a medical error and a known risk of surgery. "It should not happen, but sometimes, despite everyone's best efforts, it can happen," Olden said.

    Virginia Hospital Center has said only that Murtha received "aggressive critical care interventions."

    Any thoughts or comments?

    I've seen surgeons doing laparoscopic surgery and it's like watching a conductor at a symphony and then I've seen surgeons whose technique looks like a Three Stooges routine. Some have it and some don't those who don't should just do open procedures or better yet, do insurance physicals...

    On the other hand, the congressman may have just been very unfortunate.

    R

  3. #3
    Super Moderator cougarnurse's Avatar
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    Re: Lawmaker's death reminder of surgical risks

    Age has alot to do with it, I am sure. Of course, it sems like some think 'age is just a number', which it is. But try telling that to an aging body. Doesn't always work.

  4. #4
    Ricu
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    Re: Lawmaker's death reminder of surgical risks

    Quote Originally Posted by cougarnurse View Post
    Age has alot to do with it, I am sure. Of course, it sems like some think 'age is just a number', which it is. But try telling that to an aging body. Doesn't always work.
    Very true. Still, considering that it's routine for seventy-somethings to have CABGs and joint replacements, you'd think a lap-chole would be nothing.

    R

  5. #5
    Super Moderator cougarnurse's Avatar
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    Re: Lawmaker's death reminder of surgical risks

    I doubt you can nick the bowel during a hip or knee replacement. CBG's have their own risks, not considering the patient's over-all health, lifestyle, etc.

    :offtopic: Ya know, just thinking about it, there are some really 'old' younger people. You know---the types who live hard....

  6. #6
    Ricu
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    Re: Lawmaker's death reminder of surgical risks

    Quote Originally Posted by cougarnurse View Post
    I doubt you can nick the bowel during a hip or knee replacement. CBG's have their own risks, not considering the patient's over-all health, lifestyle, etc.

    :offtopic: Ya know, just thinking about it, there are some really 'old' younger people. You know---the types who live hard....
    Yep. We have a unit full of 'em. Many are younger than me and sometimes I enjoy pointing that out.

    R

  7. #7
    Senior Member Marie_LPN's Avatar
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    Re: Lawmaker's death reminder of surgical risks

    Quote Originally Posted by Ricu View Post
    I've seen surgeons doing laparoscopic surgery and it's like watching a conductor at a symphony and then I've seen surgeons whose technique looks like a Three Stooges routine. Some have it and some don't those who don't should just do open procedures or better yet, do insurance physicals...

    On the other hand, the congressman may have just been very unfortunate.

    R
    I've seen one case where a pt. had a very thin area of small intestine, and the insufflation pressure was just enough to make the the thin area pop, so hello open chole, and SBR. Granted, a spot that's this thin would have eventually ruptured on its own, still , another example of the weird things that can happen.

    However, when i first heard this story, first thing i thought of was "was someone not paying attention?"
    [FONT=Comic Sans MS][U][B]Marie[/B][/U], RN in O.R, pursuing BSN, semester [U]?[/U] of [U]?[/U]:)[/FONT]

    [FONT=Comic Sans MS][B]Supposedly 8 out of 10 people suffer from hemorrhoids. Does that mean that the other 2 people [I]enjoy[/I] them???:confused:[/B][/FONT]
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