Coroner told of patient's bleeding

PUBLISHED : Friday, 29 July, 2011, 12:00am
UPDATED : Friday, 29 July, 2011, 12:00am


An inquest to decide whether a 51-year-old cancer patient died from her surgical wounds has heard that blood was gushing inside her body when she was found on the floor of her ward.

Wong Choi-ngor died less than five hours after suffering heavy internal bleeding, the coroner's court was told yesterday.

She had been admitted to Tuen Mun Hospital on March 3 last year for laparoscopic surgery, a minimally invasive procedure.

After the surgery, to remove a tumour in her rectum, her condition was described as normal and stable. Two days later, however, a doctor had to perform emergency surgery in an effort to save her life after she fell from her bed.

A report last year said family members who visited Wong immediately after the surgery said she had complained of feeling dizzy and tired. They were told by doctors that this was 'normal', Tuen Mun district councillor Li Kwai-fong, who is helping the family, was quoted as saying.

Wong was found unconscious in the ward at about 10.15am on March 5. She was pronounced dead at 2.50pm after emergency treatment and surgery. Her family were told she had suffered internal bleeding.

Yesterday Dr Wong Kei-kwong testified that he found large-scale blood loss behind her rear abdominal wall, which appeared to have been going on 'for some time'.

'At the time I conducted the operation, I estimated - when I saw it - that she had already lost about two litres of blood.

'There was large-scale bleeding where the previous operation had been carried out. It was like the blood was erupting from the vessels,' he said, adding that he did not have time to find any wound.

Other surgeons said the heavy bleeding, mainly found in her abdominal cavity, had been triggered by a phenomenon known as disseminated intravascular coagulation (DIC). The causes of this condition are being disputed.

Dr Pang Chun-yin, who conducted Wong's autopsy, inferred that the cancer surgery led to colitis, or inflammation of the colon.

This in turn led to DIC. But he could not confirm the link between her operation and the colitis, as the causes of the inflammation could range from blood vessels being damaged or blocked, to the improper use of surgical pumps.

'But let me repeat this,' Pang emphasised in court, 'it's very unlikely for a healthy person not undergoing surgery to have ischemic colitis ... I reasonably believe there must be some relationship [between the surgery and the colitis].'

The doctor who performed the laparoscopic surgery did not agree. 'The operation was a successful one,' Dr Tsui King-yiu said. 'I found no large-scale bleeding inside her body afterwards.'

Dr Wong disagreed that a fall could have led to Wong's death. 'A relatively young patient, like Wong, suffering from a low-energy fall, could not possibly have injured her pelvis and her peritoneum to lead to the heavy bleeding.'

The inquest continues today.