A WOMAN who underwent gastric bypass surgery for management of morbid obesity died in hospital more than three months later after developing septicaemia, an inquest has heard.
Annette Capocci (46), Charlemont, Griffith Avenue, Dublin, was admitted to Beaumont Hospital on May 21st, 2007, where she had an uneventful operation known as a gastro-jejunal bypass carried out the following day.
Ms Capocci, who weighed 148kg (23.3 stone) at the time of the surgery and had a body mass index of 53, was obese for almost all of her life and had tried all of the conventional methods of weight loss without much success, Dublin City Coroner’s Court heard yesterday.
She had a number of the major medical complications of obesity, including diabetes, high blood pressure, peripheral vascular disease, asthma and lower back pain.
The procedure was well-tolerated but in the days following the operation, Ms Capocci was unhappy with an epidural catheter and complained of numbness, first in her left leg and then in her right leg, which persisted.
The epidural, which was used to manage post-operative pain and which is routine procedure, was stopped about May 24th.
An area of reddening of the skin and a pressure sore was noted on her buttock area about the same date and Ms Capocci, who complained of pain in the area while lying in bed, was started on an antibiotic.
Meanwhile, the numbness persisted and Ms Capocci developed a foot drop. An MRI scan was advised.
Arrangements were made to have the scan carried out in the Beacon Hospital, as Ms Capocci was too large for the scanner in Beaumont Hospital, but Ms Capocci’s pressure sore increased in size, with death of skin, and her condition remained unsuitable for transfer.
She required surgery to remove dead tissue (surgical debridement) on a number of occasions, with extensive skin loss.
During her time in hospital the wound was contaminated by bugs including MRSA, e-coli and VRE, for which she received treatment. Ms Capocci never had MRSA in her blood, however.
On July 20th Ms Capocci was admitted to the intensive care unit and was given potent antibiotics and anti-fungal medications for infection.
On July 24th she was found to have fungal septicaemia, with the candida fungus in her blood.
The hospital was “dealing with a grossly obese, debilitated post-operative diabetic patient with confirmed fungal septicaemia”, surgeon Patrick Broe told the inquest.
Despite intensive treatment with antibiotics and anti-fungals, Ms Capocci’s condition deteriorated and she died on August 26th, 2007.
“Ultimately, systematic candida albicans had very serious and fatal effects on her system,” Mr Broe said.
“She would have been more susceptible to infection due to the diabetes and obesity.
“In a diabetic, healing is a big problem. She got a pressure sore and it was relentless and, following our efforts to treat this, she developed systemic infection.”
Pathologist Dr Derval Royston said Ms Capocci died from multi-organ failure due to septicaemia secondary to an extensive necrotic sacral ulcer on a background of multiple co-morbidities following surgery.
Coroner Dr Brian Farrell adjourned the inquest to facilitate the barrister for the family Breffni Gordon, who is awaiting a report from an expert.