JIMMA UNIVERSITY MEDICAL

DEPARTMENT OF SURGERY

MORBIDITY AND MORTALITY REPORT AUGUST,2024 GC

BY –DR TEGENE (GSR II)
MODERATOR – DR YOHANNES (ASS.PROF ,CGS)
 OUTLINES
• OBJECTIVES
• INTRODUCTION
• OVER ALL SPECIFIC RESULTS
• DEATH SUMMARY
• DISCUSSION
• RECOMMENDATION
• REFERENCE
August month MMR by Dr Tegene
 OBJECTIVES
• To assess over all activities of the department
in August 2024 GC.
• To identifies common morbidities.
• To assess the achievement of planned
activities of the department in August 2024
GC.
• To identifies common limitation and to put a
recommendation.
 INTRODUCTION
• Surgery is among major department in JUMC.
• Currently JUMC has more than 800 beds and 150
(18.75%) allocated to the surgical department.
General

GI Oncology

Surgery units
HPB

Cardiothoracic

Neurosurgery

Pediatric surgery
Plastic and
reconstructive
Number of beds in each ward and
No. of OR table each surgical unit.
Ward No. of bed Name of OR No. of table
Surgical A ward 36 Emergency OR 1
Surgical B ward 30 Elective general OR 1
Cardiothoracic S 5 Pediatric surgery OR 1
Burn and plastic unit 28 Neuro and urosurgery OR 1

Pediatric surgery 22 GI oncology /HBP OR 1

GI Surgery 12 Plastic/ENT/OMF/CTS OR 1

Private wing 11 Minor OR 2

ICU 6
TOTAL 150 TOTAL 8
Over all activities of August 2024 GC
• TOTAL of 1484 patient were served in
the department of which –
• 210 + 69
Admission
• =279
234 +
Elective procedure 19=252
• 195 +
Emergency procedure
18=213
Unwated outcomes
SSI •05
Death • 08
Total No. of cases seen at each unit
Unit
over the past 3 months June July August
Emergency SOPD 370 559 441
Cold SOPD 406 456 307
Surgical referral Clinic 160 68 138
GI oncology S RC 24 26 30
Cardiothoracic S RC 25 40 17
HBP RC 28 46 28
Pediatric surgery RC 48 63 57
Plastic and reconstructive RC 49 75 50

Urological surgery RC 108 108 100

Private wing 76 67 45

Total 1191 1490 1413

No. of admission over the past 3
months
Ward June July August
SA 66 70 83
SB 37 44 23
Pediatric surgery 160 68 50
Cardiothoracic S 3 23 5
GI oncology and HBP Surgery 10 / 7 18/7 13/6
Plastic and Burn unit 30/12 40/10
30 / 12

Urological surgery 13 16 16
Private wing 18 15 28
TOTAL 196 238 260
List of cases seen at EOPD over the
past 3 months
Diagnosis June July August
Soft tissue injury 224 126 191
Acute Abdomen 55 68 49
Abdominal trauma 7 2 4
Chest trauma 8 1 15
Burn 21 18 14
Abscess 12 23 20
Others 43 280 182
TOTAL 370 559 480
Common case seen at CSOPD over the past 3 months
Diagnosis June July August
Thyroid pathology – Nodular/Toxic 33 46 40/11
Breast pathology –Abscess/ breast Tumor 20 6/16
29

BOO 14 14 28
Soft tissue injury 28 25 15
Urolithiasis 13 18 1
Cholelithiasis 2 6 1
Hernia 18 12 3
Hemorrhoid 11 8 8
Esophageal/Stomach/ liver pathology 16/ 8 8 25
CRC and Perianal condition 3 3 4
Hydrocele 1 1 3
lipoma /Cyst 30 28 31
Others 145 165
193

TOTAL 406(55) 456(70) 410(42)

August month MMR by Dr Tegene

Elective GS procedure done over the
past 3 months
Procedures June July August
Thyroid surgery 18 17 8
MRM/ MRM + ALD 2 0 1/1
Inguinal hernia – Tissue/ mesh repair 6 3
6

Colostomy /ileostomy Reversal 3 5 0

Hemorrhoidectomy + Fistula Repair 0 4 2
Varicose vein surgery 2 0 0
Toilet Mastectomy & LD Flap 0 0 0
Brachial cleft cyst excision 1 0 0
Neck Dissection 0 0 1
Others (Sigmoidectomy, Biopsy, Sistrunk,) 3 3 4
TOTAL 35 36 20
 Emergency GS procedure done
over the past 3 months
Procedures June July August
Laparotomy /Re lap 39 42 30/6
Abscess drainage I&D 9 5 6
Appendectomy 6 (4) 4 9
Colostomy/Ileostomy 10 7 4
Rectal tube Defilation 1 1 6
Splenectomy 4 2 2
Others 9 11 12
TOTAL 64 74 64
Elective GI Oncology surgery procedure
done over the past 3 months
Procedures June July August
Gastrojejunostomy /exploration, By pass
Laparotomy+ Rt.Hemicolectomy + sigmoidectomy +colonic mass en block 1 2
resection (Debulking) + colorectal anastomosis

Gastroctomy, Truncal vagotomy 1 1

Modified Heller myotomy (achalasia) 0
Colostomy ,colostomy reversal 0 2
Ileostomy reversal
Colonic pullthrough + protective Ileostomy, pullthrough refashioning 1

Rt .Hemicolectomy/sigmoid colectomy 1 1
Fistuloctomy, biopsy & seton drainage, Hemorrhoidectomy

Resection of rectal GIST + Repair rectum,gastric GIST 1

Others (Biopsy, Rectal polypectomy ,Feeding jejunostomy…) 5 2
TOTAL 7 9 6
Emergency GI Oncology surgery
procedure done over the past 3
months
Procedures June July August
Gastrojejunostomy exploration 0 0 0
Rt. Hemicolectomy / sigmoid colectomy 0 1/3 3/1

Feeding Jejunostetomy /Gastrostomy 1 1 2

Exploration & Biopsy 2 5 2

Others (proctoscopy exam polipectomy) 0 1 0

TOTAL 3 8 7
Elective HPB surgery procedure done
over the past 3 months
Procedures June July August
Open cholecystectomy 0 5 4
CBD Exploration 0 1
Whipple procedure 0 0
Laparoscopy cholecystectomy
Cystectomy ,Hepatectomy 0
Laparotomy pancreatectomy 0
Mesh Repair 0
Liver hydatid cyst excision 0
Cytogastrostomy 0
Resection cholangiocarcinoma 0
Exploration + biopsy, laparoscopic biopsy 1 0

Distal gastrectomy + Billroth II anastomosis 0

TOTAL 4 7 5
09/06/2024 August month MMR by Dr Tegene 15
 Emergency HPB surgery procedure
done over the past 3 months
Procedure June July August

Open Cholecystectomy 1 3 3
Bypass ( Lap + duodenojejunostomy
+ cholecystojejunostomy
+jejunojejunostomy + Drainage )
Lap + abscess Drainage +
debridement
Lap + Liver abscess drainage +
Lavage
Total 1 3 3
09/06/2024 August month MMR by Dr Tegene 16
 Elective Cardiothoracic surgery
procedure done over the past 3
months
Procedures June July August
Pulmonary hydatid cyst excision 0

Esophagectomy 2 2 4
Sweet Esophagectomy 0 0 1
Rt. post-lateral thoracotomy 0
Pneumonectomy,Lobectomy
Mediastina mass excision + wedge resection 0
of upper & middle lobe of Rt.lung
Modified Heller Myotomy 1 1
Chest wall mass excision, Thyroidectomy 0
Ultrasound guided tube thoracostomy 0
Others(colonic interposion feeding tube)
TOTAL 3 5 5
August month MMR by Dr Tegene
Emergency CT surgery procedure
done over the past 3 months
Procedures June July August
Tracheostomy 1 0 2
Tube thoracostomy 10 4 6
Laparotomy splenectomy & diaphragmatic 0 0
repair
Feeding tube 2 0 3
Pericardial Drainage 0
Rt. PLT + Thoracic duct ligation 0
Thoracotomy laparotomy + Hernia reduction + 0
crura repair + Nison fundoplication
Others (diaphramatic injury repair) 0 1 0
TOTAL 13 5 12
 Emergency Pediatric surgery procedure done over the past 3
months
Procedures June July August

Laparotomy 2 3

1-Complicated Appendicitis

2-Open reduction for intussusception

Tube thoracostomy 2 1

I&D 5 5

Re-lap + Retention suture 5 1

Appendectomy 3

Corrective circumcision 2

Chest tube manipulation 1 1

Bronchoscopy FB removal 3 3

Hydrostatic Reduction 1 0

colostomy 2 3

Other 1
09/06/2024 August month MMR by Dr Tegene 19
TOTAL 29 18
Elective Pediatric surgery procedure done over the past 3
months0
Procedure June July August

Pull through 3 3

Excision 3

SCT-1
Wilimis tumor
Mesenteric lymphangioma
Herniotomy 2

Colostomy Reversal 2 4

Biopsy 3 1
?HL
Neuroblastoma
Hypospadia Repair -TIP 2 4

Fistula repair for post hypospadia 2 2

UCF
TOTAL 17 Next

09/06/2024 August month MMR by Dr Tegene 20

Elective Pediatric surgery procedure …

Procedures June July August

Pyloromyotomy + circumcision 1 1

High ligation 1

PSARP 1 2

Hydrocelectomy 1

Orchidopexy 1 1

Herinorrhaphy 1

Re- Lap for chronic multiple intussusception 1

Leveling biopsy 1

Mesh repair for incisional hernia 1

TOTAL 27 19
09/06/2024 August month MMR by Dr Tegene 21
Elective Pediatric surgery admission over the past 3
months0
Cases June July August
Hypospadia 5 6
Hydrocele 2 2
Hernia 3 0
Functional colostomy 3
UDT 2 1
PSARP 1 2
Pull through 3
PUV 1
Others 5 9
TOTALS 22 23
09/06/2024 August month MMR by Dr Tegene 22
Pedi surgery Overall monthly
activity
Total June July August
Emergency cases 46 36 24
Emergency procedure 26 29 17
Elective Admision 19 23 21
Elective procedure 17 27 19
PSRC 70 63 57
SSI 0 2 2
Death 3 0 3

09/06/2024 August month MMR by Dr Tegene 23

 Elective Urologic surgery
procedure done over the past 3
Procedures months June July August

TVP 3 3 5
Nephrectomy 2 3 1
Nephrolithotomy, Pyelolithotomy, pyeloplasty 4 1/1/1 1/1/1
Ureteric stenting, removal 0 1
Urethroplasty 2 3
TIP 0
Uretrolithotomy ,cystolithotomy 0 1
TURP.TURBT 0 1
Bladder neck contracture optical incision 0 0 0

Supra renal mass Exploration 0 0 0

Others (orchiopexy,orchidectomy,Biopsy) 1 3

TOTAL 12 13 14
 Emergency Urologic surgery
procedure done over the past 3
months
Procedure June July August
Suprapubic Cystostomy 1 1 1
0 1
Exploration & urethral repair 0

7 11
Percutaneous nephrostomy 14

1
Ureteral stenting (Cyst/open) 0

I&D 2 0 3
Other (stent ia dia repair) removal,Diverticulotomy,hypospa) 7 0 3
Total 24 8 21
List of cases done by Elective plastic s
unit done over the past 3 months
Procedures June July August
STSG/FTSG 6 18 10
Excision 3 1 1
Flap /Flap division 2 4 5
Keloid 0 0 0
Contracture release 3 1 2
Sclerosant injection - 1
Cleft lip & palate 22 16 13/5
Others 5 3 1
TOTAL 43 44 40
 List of cases done by Emergency
plastic s unit done over the past 3
months
Procedures June July August
I&D , Pinning 21 3 9
Corrective amputation 1 0 2
Tendon Repair 1 0 3
Exploration & nerve repair 0 1 1
Exploration vascular ligation & tendon 1 2/0 2/1
repair
Amputation 0 = 0
Others (FB removal ,suturing ) 6
TOTAL 24 6 24
Elective Consultation Plastic &
reconstructive Surgery procedures done done
over August 2024
Consulting Procedure Total
department
Orthopedic Surgery Flap
STSG 3
Nerve /Tendon 1
Repair
Internal Medicine I&D
General Surgery 1
Maxillofacial 1
TOTALS 6
09/06/2024 August month MMR by Dr Tegene 28
 Private wing procedure done over the
past 3 months
Procedures June July August

Open cholecystectomy 1 3 1
Truncal vagotomy 0 0 1
TVP,TURP,TURBT 3 1 1
Open lichenstein hernioraphy ,hernioraphy ,PPV repair 1 1 0

Pyelolithotomy ,ureterolithotomy,nephrolithotomy,nephrocto 1/1/1/1

my
MRM 2 0 2
Thyroid surgery 3 4 7
Well procedure for rectal biopsy 0 0 0
CBD Exploration 0 0 0
Laparoscopic renal cyst excision /ablation 0 2 0
Bilateral orchidectomy 0
STSG, Contracture release/ tendon repair 1/2/1
Others(Nephrectomy,Flap,biopsy,excision ,fistulectomy) 5 5 3
TOTAL) 15 15 23
 Elective procedure in minor OR done
5
over the past 3 months
June July August
Regular Private Regular Private Regular Private

Biopsy 5 16 12 8 12 09 21
Lipoma excision 6 7 8 7 04 06 10
Fibroadenoma 0 3 2 4 8 00 8
Cyst excision 6 2 5 2 11 01 12
Epigastric Hernia Repair 3 2 2 2 03 04 7
Circumcision 2 3 4 2 06 00 6
Hydrocelectomy 2 3 1 0 04 01 5
Orchidectomy 0 0 1 0 00 00 0
Cystoscopy 6 20 6 20 21 03 24
Stent insertion /removal 0 /7 0 0 1 02 00 2
Cleft lip & palate 22 0 16 0 14/5 00 19
Others 0 0 0 0 0 0 0
TOTAL 40 54 81 24 10
59 56
5
115 94 105
August month MMR by Dr Tegene
Emergency procedure in minor
OR done over the past 3 months
Procedure June July August
Laceration repair 43 44 31
I&D 6 6 10
PCN 14 7 7
Cystoscopy 1 23 1
Tube Thoracostomy 4 4 1
Amputation correction 1 1 0
Suprapubic cystotomy 1 2 0
Other 3 2 16
Total 73 94 76

09/06/2024 August month MMR by Dr Tegene 31

 Interdepartmental
consultation done over the past
Department 3 months June July August
Pediatric & child health 0 2 2
OBS/GYN 3 3
Internal medicine 5 3
Psychiatric
Oncology
Orthopedic & Trauma Surgery 1
EOPD 2 3
ICU 1 3
Maxillofacial surgery
TOTAL 6 7 15
• Common cases consulted
Cases consulted June July August
FB
Abscess 3
General peritonitis/ obstruction
Acute appendicitis /Acute pancreatitis

IHPS,HSD,ARM
Intussusception
Complicated pneumonia 4
Omphalocele / Gastrochisis
Obstructive uropathy 3
Empyema 1 3 2
TEF
Others 5 4 3
TOTAL 6 7 15
 Cancellation rate of elective surgery
August,2024 GC.
Units planned operated Cancelled Cancellatio Reason for cancellation
n rate

General S 12 10 2 17% Patient condition+

GI oncology S 4 3 1 25% Shortage of time

Pedisurgery 21 19 2 9.5% Ruptured of anesthesia medication, no

schedule for 1 wk
Cardiothoracic S 6 5 1 20% Patient condition

HPB S 9 7 2 23% Patient condition

Plastic Surgery 49 4 1 8% Time, Patient .condition, Anesthesia drug

Urological S 13 11 2 16% Lack of anesthesia med.

Private wing 23 23 0 0%

NB- In general ruptured of anesthesia medication is the big challenge of

this month –Missed to schedual.
Comparison of cancellation done over the
past 3 months
units June July August Remark
General Surgery 18.8% 17% Ruptured of
23.9% anesthesia

GI oncology Surgery 12.5% 25% medication

33.3%

Pedi surgery 9.5%

Cardiothoracic Surgery 25% 16.6% 20%
HPB Surgery 33% 0% 23%
Plastic Surgery 12.2% 5.2% 8% ????
Urological S 29.4% 12.5% 16%
Private wing 0 0 0%

09/06/2024 August month MMR by Dr Tegene 35

Surgical Site infections August 2024
GC
Surgery Department JUMC
 Surgical Site Infection , August
2024 GC.
Ward Superficial SSI Deep SSI Organ Space SSI TOTAL

SA 1 1 2
SB 0
Pedi surgery 1 1 2

GI oncology Surg 0

HPB 0
CT surgery 1 1

Urology surgery 0
TOTAL 03 02 03
 List of SSI Cases
S Name Age Sex Unit Surgery done Types Detected Risk Mx LOS Out come
N of SSI POD Factors after
SSI
1 Moham 35 M CT Esophagectomy SSSI On 7th POD SAM Wound 3WK Improved,
medsani care ,QB Discharged
2 Kemila 30 F SA Re-Lap + Deep On 4th POD Emergency On 2 wk Improved
Gali Colostomy + Re lap surgery Wound
ileostomy+ Dirty wound care
SAM (2.05) AB

3 Zulale 20 F SA Laparotomy for SSSI On 5th POD Emergency On wound 3 wk On care

kerima Perforated surgery care
Appendicitis Dirty wound

4 Baby 9 M NICU Divided DSSI On 7th POD Emergency I&D, 9day Improved
Samira day sigmoidostomy for surgery stoma Continuous
ARM Stoma Refashion wound care
,
AB
5 Arier 29 F PSW Divided SSSI ON 6th POD Emergency Wound 6 day Improved
oloak day sigmoidostomy for surgery care Continuous
ARM (RVF) Stoma wound care
Mortality Report for August 2024 GC

Surgery Department JUMC

Mortality Report
SN Pt Name Age /sex ward Diagnosis LOS Cause of Death

1 Hd / Taju 70/F ICU  Immediate POD I&D for post op Abdominal wall NF 3D MOF 2* Septic
A/ Temam  on 2nd POD Lap. + En block Resection Lt. Colonic constrictive shock
mass + DC. Colostomy for LBO

2 Miftaha A.Raya 30/M SA  2nd POD Re-Lap + REE ileoileal Anastomosis + DB Ileostomy + 3D Sudden
Retention suture done for Intussusception Cardiac Arrest
 on 15th POD Laparotomy
3 Nezimu 25/M SICU  Immediate POD lap + Rt. Hemicolectomy + ES –Ileotransversal 1D MOF 2* Septic
A/badir anastomosis Done for GP 2* SBO 2* Cecum mass 2* Shock
 AKI (1.7) + Hyperkalemia (5.5)

4 Mulegeta 40/M SICU  2nd POD after Exploratory Laparotomy done for Hemoperitonium 2* Blunt 3D CRF 2* Raise
Wondimu TAI ICP
 Pelvic Fracture+ Lt. Lung Contusion (thoracostomy Done)
 PANCYTOPNEA (Severe anemia & thrombocytopenia) 2* NCNC 2*

5 A/Kerim Abadir 30/M OR  Immediate 4 hr post op EXP.Lap for GP 2* Gangrenous SBV with 4Hr Septic shock
ACS (GI focus)

6 Baby 9 day NICU  Laparotomy + Biopsy + loop ileostomy for HSD 5Hr RF 2* LONS
Tarike
7 Baby Hajera 45 day NICU  Anterior abdominal wall NF 4Hr MOF 2* Severe
sepsis
8 Farida 11 yr SICU  Laparotomy + Appendectomy + lavage for GP 2* per.Appedicitis 4 day MOF 2* Septic
Muftahi shock
 1. Hd / Taju A/ Temam
70/F Date =04/12/16 EC.
A184494 EOPD
Dx –AA 2* GP 2* LBO 2* ? Colon Mass + AKI
H
i Abd. Distention (exacerbated) * 01 wk No known comorbid disease
s Hx. No prior surgery
t Failure to pass feces & flatus *01 day. Come from private hospital
o Vomiting (ingested matter).
r Bowel habit change *01 yr Hx.
impression ? Colon mass
y
TB TREATED Hx of 20 yr back
Abd-
P  Groosly distended
h G/A– ASL on Chronic back ground  Hyper tympanic
y
si
V/S= BP =110/70 PR=108- 110 RR=26  hypoactive bowel sound,
c T=36.6C* SPO2  Diffuse tenderness
a
l HEENT- PC & NIS  DRE- Empty
E Chest – clear & Bi. good air entry CNS- COTPP
x
a
m
MGT –Resuscitated 2L NS ,Double AB
- Double AN, Prepared for OR (NGT, Urine
catheter)
09/06/2024 August month MMR by Dr Tegene 41
1. Hd / Taju A/ Temam Date =04/12/16 EC.
70/F
A184494
Investigation 04/12/16 5/12.1 6/12/16
6
CBC WBC-6.4K ,Lymph %-17.8% 3.2k ICU
RBC -5.84M/ Hgb -16.2 HCt - 3.9M
49.6 10.2/30.9%
PLT-222K 101K
BG/RH O+
Viral marker Negative PH -7.15
OFT Cr -1.9 Cr - 1.9
1.68
Electrolytes Na /K/ Cl -131/4.3/91.7 149/3.4/138
Abd Pelvic US Gaseous Abd - LBO
Plain Abd X-ray Partial LBO
Contrast Abd Dilated cecum, AC,TC & Prox. DC with smooth trapped proximal dilation and
09/06/2024 August month MMR by Dr Tegene 42
CT scan distally collapsed segment (likely stricture 2 * IBD,TB) No evidence of
 1. Hd / Taju A/ Temam Date =04/12/16 EC.
70/F
A184494
Operated on the some day of arrival 04/12/16
Done –
 Laparotomy + En Bloc Resection lt.colon constrict mass +
 Lt. Hemicolectomy + CME + TC Colostomy
 Biopsy

IOF –
 Reactive fluid in general peritoneum, Dilated LB Proximal to descending colon,
 obstructing mass at junction of DC & SC, Sigmoid colon collapsed,
 No LAP, no deposit ,Liver grossly normal
Intra op V/S – Normal Range (MAP 65mmHg)

Post op Order –
 MF
 Metronidazole 500mg IV TID, Ceftriaxone 1gm IV BID
 Tramadole ,Diclofenac,
 Stoma care, sample Histopathology
 Post op care

09/06/2024 August month MMR by Dr Tegene 43

1. Hd / Taju A/ Temam Date =05/12/16 EC.
70/F
at SA Ward
A184494

Vital Sign
date Time BP PR RR T SPO2
4/12/16 6-8 pm 110-120/ 78-110 22-24 36.7c* 94-96%
68-72
5/12/16 100-120/ 82-112 24-34 36.5- 90- 76%
60-72 37.2C* Off o2
Put on INO2

09/06/2024 August month MMR by Dr Tegene 44

1. Hd / Taju A/
Temam
70/F
Date =06/12/16 EC.
A184494

 On 2nd POD after Laparotomy + En Bloc Resection lt. colon constrict mass + Lt.
Hemicolectomy + CME + TC Colostomy + Biopsy
New complain –
 SOB
Date Time BP PR RR T SPO2
 Lt.abdominal pain (severe)
 Concious 4/12/16 6-8 110-120/ 78- 22-24 36.7c* 94-96%
 On sips ,ambulating but she repeatedly pm 68-72 110

complain colostomy site pain 5/12/16 100-120/ 82- 24-34 36.5- 90-
60-72 112 37.2C* 76%
 Skin Discoloration on colostomy site Off o2
(recognized by senior) Put on
INO2
Physical Exam – G/A –ASL (CRD) V/S-
6/12/16 10AM 80/50 120- 32-40 = 84-88%
Abd – soft ,functional colostomym 140 on
 LLQ ecchymosis lesion INO2

Investigation – CBC pancytopenia WBC 3.2k

CBC
RBC -3.9M /10.2/30.9%
DX –Postoperative Abdominal wall
NF On 2nd PoD Laparotomy 101K
 Prepared and Taken to OR
09/06/2024 August month MMR by Dr Tegene 45
 1. Hd / Taju A/ Temam Date =06/12/16 EC.
70/F
A184494
DX - Postoperative Abdominal wall NF
Taken to OR
IOF
Left Abdominal wall positive for finger test Skin Incision done on
abdomen
Done -  Absence bleeding
 I & D Done + tissue culture  Dirty dishwater coloured fluid
 Limiting incision at Lt. inguinal & subcostal area  Discoloration of the fat
 Abd. Not opened
 Dressed wound
 #2 unit WBC transfused
 On Vasopressor 0.5mg/kg initiated MAP 65
Transfer to SICU
 Stay Only for 12 Hr
 AB Revise - vasopress , Hydrocortizon 50mg iv QID MF,
ceftazidinne ,vancomycine, metrodazole
 ICU V/S

09/06/2024 August month MMR by Dr Tegene 46

1. Hd / Taju A/ Temam
70/F Date =06/12/16 EC.
A184494 ICU

 adrenalin drip

Death 2* MOF 2* Septic shock 2 post OP Abd wall

necrotizing fasciitis
CPR Tried failed
Post mortem care done discharged
Death 2* MOF 2* Septic shock 2 post OP Abd wall
necrotizing fasciitis

Post op Abd wall

Nf
 a rare and fatal complication Strength – Early Diagnosed and
managed.
 A 60.F on 2nd day after surgery for LBO ? ICU
MR in this pt is 50-80% Vasopressor ,room tempreture
Morbid triad

Our pt has risk Antibiotic regiment is revised

 Age Advanced AB Is recommended.
 major surgery
 colon malignancy
 AKI
09/06/2024 August month MMR by Dr Tegene 48
 2.Miftaha A/Raya
30/M Date =15/12/16 EC.
A186281

At EOPD Dx-
p1- AA 2* SBO 2* post op ilioiliocolonic Intussusception (13th poD
Laparotomy)
H
• C/c- failure to pass feces & flatus * 10 day ,vomiting
i
s (ingested matter ,multiple episode)
t •
o
Abd pain & distention.
r • No known comorbid disease Hx
y
Abd-
P G/A– ASL on Chronic back ground  Midline sutured surgical scar
h
y
V/S= BP =108/80 PR=120 RR=24  Rt. Lateral mass 6*3 cm non tender &
si T=36.6C* SPO2 -96% off O2 mobile
c  Flat & move with respiration
a HEENT- dry tongue & oral mucosa  hyperactive bowel sound,
l Chest – clear & Bi. good air entry  DRE- formed stool
E
x CNS- Confused
a
m
MGT –Resuscitated 2L NS ,Double AB
- Double AN, Prepared for OR (NGT, Urine
catheter)
09/06/2024 August month MMR by Dr Tegene 49
IX- next
 2.Miftaha A/Raya
30/M Date =15/12/16 EC.
A186281

Investigation 15/12/16 17/12/16

CBC WBC -9.38k N% 80.5% 14.7K N-91.6%

RBC-3.74M/10.5/31.4% Hgb -11.3
HCT- 33.5%
PLT -241K 218k
BG/RH O+
RBS 81 mg/ml 180
OFT Cr - 1.34 0.92
Electrolytes Na/K/cL- 140/3.15/101 147/3.07/114

09/06/2024 August month MMR by Dr Tegene 50

 2.Miftaha A/Raya
30/M Date =15/12/16 EC.
A186281

Prepared to operate Taken to OR

IOF
• Up on Opening previous midline surgical wound Intra op V/S – Normal Range
(MAP 65mmHg)
• Minimal reactive peritoneal fluid
Post op Order –
• Complete fascia dehiscence at lower abd.  MF
• Long segment ileoileal intussusception about 15cm from  One unit WBC Transfused.
ICV & the 2nd is 70cm from 1st one.  Metronidazole 500mg IV
• Segment of SB Proximally is 150cm. TID, Ceftriaxone 1gm IV BID
• Multiple small LAP on SB mesenteric,No gross pathology  KCL 20mEq IV TID
found.  Tramadole ,Diclofenac,
DONE
• Intussuscepted segment resected.
• Distal remain ileum anastomosis with remain distal
ileum.
• Proximal segment brought as double Barrel ileostomy.
• 09/06/2024
Lavage & Abd. closed with retention suture.
August month MMR by Dr Tegene 51
 2.Miftaha A/Raya
30/M Date =16/12/16 EC.
A186281

• P1- Immediate POD REE Ileoileal Anastomosis + Double Barrel Ileostomy + Retention
suture done
• P2- On 15th POD laparotomy done
• P3 – ? HAI (Chest Focus)
New development
 SOB
 V/S –
 Chest –Bi. lower lung field decrease air entry
 Abd- clear dressed mid line surgical wound, no sign of
fluid ,functional ileostomy
 NS- Lethargic
 IX -
Post op V/S
date Time BP PR RR T SPO2 RBS
16/12/16 7-4 105-124/ 88- 24-36 36.5-37.4c* 88-94% on 222 mg/dl
pm 75-90 124 INO2
17/12/16 8-5 93-110/ 102- 36-40 36.8-37.2 5C* 90- 76%
09/06/2024 AM 65-70 128month MMR by Dr Tegene
August Off o2 52
Put on INO2
 2.Miftaha A/Raya
30/M Date =17/12/16 EC.
A186281

I x-
 Chest US- Bi. lung consolidation & Bi. pleural
Effusion
 CBC,RFT,RBS,
Investigation 15/12/16 17/12/16
CBC WBC -9.38k N% 80.5% 14.7K N-91.6%
RBC-3.74M/10.5.31.4% Hgb -11.3
HCT- 33.5%
PLT -241K 218k
BG/RH O+
RBS 81 mg/ml 180
OFT 1.34 0.92
Electrolytes Na/K/cL- 140/3.15/101 147/3.07/114

09/06/2024 August month MMR by Dr Tegene 53

 2.Miftaha A/Raya
30/M Date =17/12/16 EC.
A186281

P1- on 2nd POD REE Ileoileal Anastomosis + Double Barrel

Ileostomy + Retention suture done
P2- On 16th POD laparotomy done
P3 – HAI (Chest Focus)
Management Revised
 Antibiotic Revised
ceftazidime 1gm Iv BID ,Vancomycine 1gm Iv TID
 KCL 30 mEq IV TID
 Loperamide 2mg po TID
 Cimetidine 200mg IV TID
 Diclofenac & Tramadol continued
ceftazidime 1gm Iv BID
Dosage 1gm iv TID max 6gm
Death 2* sudden cardiac Arrest Recommended

Post mortal care done discharged

August month MMR by Dr Tegene 54
09/06/2024
 3.Nazimu A/Diga
25/M Date =18/12/16 EC.
A186592

At EOPD Dx-
p1- AA 2* GP 2* SB Volvulus 2* ?colonic mass
H • C/c- Abdominal pain (colicky)* 2 day • Yellowish discoloration of eye 3 yr
i
s • Abdominal distention. back & treated with unknown herbal
t • Failure to pass feces & flatus medication
o • No known comorbid disease Hx
• History of some illness 1 yr back
r • Referred from Agaro GH (No
y
labsheet)
Abd-
P G/A– ASL (pain)  Grossly distended
h
y V/S= BP =100-120/70-80 PR=104  Generalized tenderness
s
RR=24 T=36.6C* SPO2 -99% off O2  hyperactive bowel sound,
i
c HEENT- dry tongue & oral mucosa,PC &  DRE- Empty rectum
a
l NIS CNS- alert
E Chest – clear & Bi. good air entry
x
a
m

09/06/2024 August month MMR by Dr Tegene 55

 3.Nazimu A/Diga
25/M Date =17/12/16 EC.
A186592

Investigation 18/12/16
CBC WBC -5.2k N% 75.7%
RBC-4.93 M/14/43%
PLT -143K
BG/RH A+
RBS 81 mg/ml
OFT 1.77
Electrolytes Na/K/cL- 138/5.51/106.7

MGT – Opened double IV line Resuscitated with NS ,Double IV AB

- Prepared for OR (NGT, Urine catheter)

09/06/2024 August month MMR by Dr Tegene 56

 3.Nazimu A/Diga
25/M Date =18/12/16 EC.
A186592

Prepared to operate Taken to OR

IOF
• Frank pus in general peritoneum estimated 1.5L Intra op V/S –
Stable
• SB volvuluted on cecum mass
Post op Order –
• Necrotic posterior Cecum around mass  BP start to drop
• SB Dilated  One unit WBC Transfused.
DONE  Vasopressor started
• Pus sucked out  Metronidazole 500mg IV
• SB Derotated TID, Ceftriaxone 1gm IV
BID, Ciprofloxin 4oomg IV
• Cecum mass mobilized retroperitoneal
BID
• Rt. Hemiolectomy with Ileotransfersal Anastomosis done  KCL 20mEq IV TID
• Multiple nodules on liver and gall bladder  Tramadole ,Diclofenac,
• Lavage and Drainage left in the Rt.pelvic

09/06/2024 August month MMR by Dr Tegene 57

 3.Nazimu
A/Diga Date =19/12/16 EC.
25/M
A186592

date Time BP PR RR T SPO2 R Remark

B
S
18/12/16 1pm 110/ 70 110 30 36.3c*

19/12/16 4 PM 110/65 110 36-40 36.8-37.2 5C* 90- 76% Adrenalin drip
Off o2
5 PM 90/40 104 Put on INO2

Profound 6-8AM 33-70/27-45 Not 36.3 = = Escalated 20-

hypotension palpabl = 40 drip/min
e

19AM Not recorded =

Death 2* MOF * Septic shock

Post mortal care done discharged

09/06/2024 August month MMR by Dr Tegene 58

 5.Mulugeta Wondimu
27/M
A186951
Date =19/12.16 EC

P- GP 2* Blunt TAI 2* viscus organ perforation 2* Land

sliding Accident
P1 – Pelvic
• Fracture
C/c –land + Lt.
sliding injury of 2Lung Contusion (thoracotomy
day duration Done)
No other injury site
H
• Injury on his back ,Abdominal & Pelvic areq No comorbid disease Hx
i
s • Abdominal pain, pelvic pain No prior surgery Hx
t • SOB Refer from Mizzan Teppi Teaching
o • Abdominal distention ,unable to pass feces & hospital Dx – unstable pelvic fracture
r flatus of 1 day duration.
y

G/A– ASL (pain) Plan –

V/S=  Resuscitation
P  BP =106 /70 PR- 133-140 RR- 32 T=37.1C*  Prepare for OR
h
y
 SPO2 -80% off O2 90-92% on 7L INO2  Double AB started
s HEENT- Pale conjuctiva mNIS  Transfused #1 WBC
i Chest – clear & Bi. good air entry
c
Abd –Diffused guarding & tenderness all over IX ––FAST,CBC,OFT, BG/RH, Serum
a
l  Hypoactive bowel sound electrolytes
E  DRE –Lax anal tone
x
a NS= GCS -15/15(MVE/6/4/4)
m
09/06/2024 August month MMR by Dr Tegene 59
Investigatio 19/12/16 20/12/16 22/12/16
n
CBC WBC=1.9K Gra 1.06k 2.1k
=78% N=68%
RBC-2.48M 2.22M 3.08M
HGB=8.1/23.6% 6.5/19.5 9.5/28.1

PLT -85K 66K 94K

BG/RH B+
OFT LET -AST 215 Increased *14
Electrolytes Na/K/Cl Normal

ECG

U/A

FAST
09/06/2024 Splenic & pelvic collection
August month MMR=heamoperitoneum
by Dr Tegene 60
 5.Mulugeta Wondimu
27/M Date =20/12/16 EC.
A186951

Operated on the next day on 20 /12/16

Intra op V/S – Normal Range (MAP 65mmHg)
Done –
 Exploratory Laparotomy Post op=
 Delay awakening plan to adm SICU
 In PACU
IOF –
 Minimal intra peritoneum hemorrhagic fluid BP=113-120/61-75 PR=121-146
 Pelvic retroperitoneal hematoma *non extended RR= 24-38 T* ??
 Urinary bladder contused but intact
 Contusion on sigmoid colon , Ascending colon & Post op Order –
 MF
cecum.  Metronidazole 500mg IV TID, Ceftriaxone 1gm IV
DONE –
 Fluid sucked out BID
 Tramadole ,Diclofenac,
 Solid organ & viscus hallow exposed and are
 Phenytoin 1gm po loaded for seizure 2* ? HIE
intact.  Diazepam 10mg iv PRN
 Diaphragm exposed & it is normal
 Vasopressor started
 Lavage & closed Abdomen.
 Transfuse #3 Unit WBC
 Post op care & V/S

09/06/2024 August month MMR by Dr Tegene 61

 5.Mulugeta Wondimu
27/M
A186951
Date =20- 21/12/16 EC.

 On 1st POD after Exploratory Laparotomy done for Heamoperitonium 2* Blunt TAI
 Pelvic Fracture+ Lt. Lung Contusion (thoracotomy Done)
 PANCYTOPNEA (Severe anemia & thrombocytopenia) 2* NCNC 2* ??

date Time BP PR RR T SPO2 GC Adrenalin

S
2O/12/16 3 -5 PM 101-106/ 137-148 30-40 37.1-37.6C* 90-92% 15 5micg/min
57-74 INO2
21/12/16 5pm -7AM 142-108/ 134-154 12-20 36.6 - 89-100% Transfused
55-85 37.2c* WBC

7;50- 11 90-110/ 130-134 12-16 = 96-100% 40drop/min

AM 44 -65

6PM HOLD

1PM 110-136/ 142-150 18-N20 37.5-37 C* 98-100%

56-80
ON 22/12/14 =On 2nd POD
IX – CBC,LET
09/06/2024 August month MMR by Dr Tegene 62
Investigatio 19/12/16 20/12/16 22/12/16
n
CBC WBC=1.9K Gra 1.06k 2.1k
=78% N=68%
RBC-2.48M 2.22M 3.08M
HGB=8.1/23.6% 6.5/19.5 9.5/28.1

PLT -85K 66K 94K

BG/RH B+
OFT LET -AST 215 Increased *14
Electrolytes Na/K/Cl Normal

PH 7.4
U/A

FAST
09/06/2024 Splenic & pelvic collection
August month MMR=
by heamoperitoneum
Dr Tegene 63
 5.Mulugeta Wondimu Date =22/12/16 EC.
27/M
A186951

Death 2* CRF 2* Raised ICP

Post mortem care done

Discharged

Not transfuse approaprate blood

FFP.PRBC PC?

09/06/2024 August month MMR by Dr Tegene 64

 6.A/Kerim Abadir
30/M Date =23/12/16 EC.
A187507

On arrival day -
p1- AA 2* GP 2* ? Gangrenous SBO 2* ? ISK I + Hypovolemic Shock
H • C/c- Abdominal pain * 10 Hr • No prior surgery history or trauma
i
s • Periumblical then become diffuse • No known comorbid disease Hx
t • Vomiting (Bilious) multiple episode
o
• Abdominal distention
r
y • Failure to pass feces & flatus *10 Hr Abdomin –
 Grossly distended
P G/A– ASL (pain)  Rigid board like abd with Hypoactive
h bowel sound
y
V/S= BP =80 /50 PR- 104 (feeble) RR- 32 T=37.1C*
s SPO2 -98% off O2  Diffused tenderness
i HEENT- dry tongue & oral mucosa,PC & NIS  DRE – formed stool
c NS - COTPP
a
Chest – clear & Bi. good air entry
l
E
x
a
m

09/06/2024 August month MMR by Dr Tegene 65

 6.A/Kerim Abadir Date =23/12/16 EC.
30/M
A187507

MGT – Opened double IV line Resuscitated with 3NS ,Double IV AB

- Prepared for OR (NGT, Urine catheter)
P – Investigation

Investigation 23/12/16
CBC WBC -16.2 k Gra % - 93%
RBC-5.2 M/15.3/48%
PLT -249K
BG/RH A+
RBS

OFT

Electrolytes

09/06/2024 August month MMR by Dr Tegene 66

 6.A/Kerim
Abadir Date =23/12/16 EC.
30/M
A187507

Prepared to operate Taken to OR =Midline

laparotomy
IOF
• Gangrenous SB with 720*= Degree counter clockwise
Intra op V/S –
 Up on abd opened BP dropped 70/40 mmHg again
and
volvuluted on it mesentery.  vasopressin (Noradrenaline 0.05mic gram/kg
• Reactive serosageous fluid estimated 1L in general /min ) plus #1 WBC Transfused
peritoneum.  BP became low normal range
• Ileum & jejunum iatrogenic perforated distance 40cm  PR 80-120 T* ?? SPO2 -100% on Machine
from DJ.  Again BP drop while closing fascia the
 Escalated Noradrenaline ? Plus Hydrocortisone
• Resected gangrenous 150cm segment SB 300cm far
100mg iv given
from DJ, only 5cm ileum spared at ICV.  Delayed on table
• Bleeding from multiple segment of jejunum ?congenital  SICU Consulted no free MV
jejunum stenosis. Post op Order –
DONE  MF
 Continuous Noradrenaline ? Plus
• Fluid sucked out  Hydrocortisone 100mg iv QID
• SB Derotated clockwise ,Resected gangrenous ileum  Metronidazole 500mg IV TID, Ceftriaxone 1gm
• End ileostomy ,sigmoid loop colostomy IV BID,
• Jejunum repaired 0.5cm by single layer and lavage  Cimetidine 2oomg IV BID
 KCL 20mEq IV TID
done.
 Tramadol ,Diclofenac,
09/06/2024 August month MMR by Dr Tegene 67
 6.A/Kerim
Abadir Date =24/12/16 EC.
30/M Death
A187507

Death 2* Septic shock

 On immediate 4 Hr post op after Laparotomy + resected Gangrenous ileum
+ end ileostomy + loop sigmoid colostomy + Lavage done for ACS 2* GP 2* Gangrenous SB
volvulus 2?
 Delayed Awakening
 Collapsed on OR table
Postmortem care done
Discharged

Side /Factors Decision

Anesthesia Vasopressor escalation

Oxygen cylinder not checked

Surgeon Length of IOP

Damage control surgery
Antibiotic regiment ,dosage …
UFH – risk vs benefit

Patient condition ACS

Septic shock

Set up /Facility Room temperature – COLD = lethal Triad

Blood component like FFP,PRBC,PC…not enough available
09/06/2024 SICU Bed shortage
August month MMR by Dr Tegene 68
 7.Baby Tarike
9day/M Date =15/12/16 EC.
Death
Death 2* Respiratory Failure
laparotomy done
DX – on 5 Hour post op laparotomy + Loop
th
IOF- disteded bowel loop
ileostomy done for HSD (TCA). Done – identified Transition zone
C/C-failure to pass feces & flatu since birth. Biopsy take, Loop ileostomy done
Abdominal distention & Bilious vomiting. Transfer to NICU with stable VS
Post op order-
P/E- G.A –ASL (Pain) ,no gross deformity
V/S – BP - PR 140-160 RR -44-50 T –
Double AB, MF, On heater,INO2
HEENT –Dry tongue & oral mucosa
Abd –Grossly distended, hyperactive bowel
Investigation 13/12/16
sound
GUS –NEMGF
OFT =T. Bilirubin. DB 18mg/dl 1.17
NS- irritable Cr 0.6
IX –
MGT – prepared fo OR Acute inf.markers CRP /hs CRP 178 / 5 mg/dl
– Rectal Enema BID
Serum electrolytes Normal except K-5.34

CBC WBC 1.97 N-63%

Postmortem care done HGB=16

Discharged PLT =113K

09/06/2024 August month MMR by Dr Tegene 69

 8.Baby Hajera Date =12/12/16 EC.
45day/F Death

Death 2* MOF 2* Severe Sepsis on 4 th post op I&D done for Anterior

Abdominal wall NF
DX – on 5th Hour post op laparotomy + Loop Figure test positive
ileostomy done for HSD (TCA). Skin Incision done on
IOF =
abdomen
C/C- periumblical skin discoloration, Done –  Absence bleeding
Skin rash on Abd, thigh , =I&D + Irrigation done  Dirty dishwater coloured
abd distention Limiting Incision done fluid
 Discoloration of the fat
P/E- G.A –ASL (Pain) ,no gross deformity
V/S – BP - PR 140-160 RR -44-50 T –38,2 c*
HEENT –Dry tongue & oral mucosa Transfer to SICU with
Abd –Grossly distended umbilicus exerted & unstable VS
infected, erythematous lesion
GUS –NEFGF Post op order –
NS- irritable AB,MF, ON O2
IX –
MGT – prepared fo OR
– Rectal Enema BID

Postmortem care done

Discharged
09/06/2024 August month MMR by Dr Tegene 70
 9.Ferida Muftahi
11 yr /F
Date =22/12/16 EC.
Death
Death 2* MOF 2* Septic shock
4th POD laparotomy + Appendectomy + Lavage done for perforated
Appendicitis
DX – AA 2* GP 2* perforated P/E- G.A –ASL (Pain)
V/S – BP - PR 120-140- RR -38 T –
Appendicitis
38,8 c*
HEENT –Dry tongue & oral mucosa
C/C- abd. Pain & vomiting * 3day duration.
Abd –Grossly distended
- diarrhea Hx, HGIF,Anorexia,Nausea
- Diffuse tenderness
- No trauma Hx
- hypoactive bowel sound
- No comorbid disease Hx
-DRE –dry stool
- Went to near by HF iv Ceftriaxone given
NS- lethargic
for 1 day
IX –

09/06/2024 August month MMR by Dr Tegene 71

 Date =18/12/16 EC.
9.Ferida Muftahi
11 yr /F

MGT – Resuscitated with NS ,Double

-IV AB, Catheterized ,prepared for OR

Laparotomy done
Investigation `18/12/16 IOF =800ml pus intraperitoneum,
CBC WBC -15.5 k N% - 86% perforated appendix
RBC-4.5M/36.5% Done –
PLT -223K =sucked out pus
US Suggestive viscus perforetion =appendectomy done + lavage
OFT - Cr 1.54
Transfer to SICU on MV
Electrolytes Normal xcept Cl -110
Post op VS – Bp Dropped Adrenalin started
0.33micg/kg/min
Ceftriaxone,vancomycine & Metrodazole
Morphine 3mg iv BID

09/06/2024 August month MMR by Dr Tegene 72

 9.Ferida Muftahi
11 yr /F

p1 – on 3rd POD After Lap + Appendectomy done In

SICU on MV
P2 –septic Shock (corrected)
P3 –Hypothermia (corrected) + AKI
Vital PR BP GCS MAP SIMV CBC
sign
21/12/16 115-140 119/75 6T -3/T/3 68 FIO2 20K –
=40 WBHGB-
PEEP 8 12,9

Death 2* MOF 2* Septic Shock

Postmortem care done

Discharged
09/06/2024 August month MMR by Dr Tegene 73
 Recommendation
• Migration to Electronic Medical recording system
• SSI documentation
• Laundry machine capacity should be looked at.
• Availability of Anesthesia medication should be
improved.
• Mandatory to have Formal meeting with anesthesia
department.
• …
09/06/2024 August month MMR by Dr Tegene 74
 Reference
• Daily Morning reports (MMR)
• Operation logbook
• Daily OR schedule archive
• Ward admission registers
• OPD Registers
• Previous Months MMR