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Post-operative infections, sepsis can trigger a stroke

Unrecognized bowel perforations during abdominal surgery can lead to deadly complications when not timely diagnosed and surgically repaired

A woman in her 50s went to a hospital to have a bariatric conversion procedure. 

Over a decade earlier, she had a lap band procedure, but had recently started having problems with nausea, vomiting, and diarrhea. After consulting with her bariatric surgeon, she decided to have her lap band removed and convert over to a gastric bypass.

Unfortunately, during the conversion surgery, the surgeon perforated part of her bowel and didn’t recognize it. The operative report noted no complications, and in the recovery room she seemed to do well and was transferred to a med/surg floor for post-operative monitoring.

Within a few days after surgery, family members told the nursing staff that the patient was confused and unresponsive. Nurses confirm that she was nonresponsive and documented that she had a fever, low blood pressure (hypotension), and foul-smelling drainage at the site of her surgical wound.

The general surgeon took the patient to the operating room and found a leak at the anastomosis site, which he repaired. An anastomosis site is where two naturally unconnected body parts are surgically connected. In a typical gastric bypass, for example, there’s an anastomosis site where a loop of the small intestine is connected to the stomach pouch.

During the repair surgery, the surgeon found a large volume of bad-smelling fluid in the patient’s abdomen. For the days after first surgery until she was returned to the operating room, the patient’s bowel contents were leaking into her abdominal cavity. She developed a smoldering infection and sepsis.

The facts in this story, so far, are things that we hear quite regularly from potential clients. Based on handling many such cases, we recognize that it’s normally not a deviation of the standard of care or negligence for an accidental bowel perforation to occur during abdominal surgery. Rather, the focus is on whether the nurses, physicians, and surgeons timely recognized post-operative complications and acted on them.

In this particular case, though, there was an added complication on top of the infection and sepsis. After the second surgery, the patient was transferred to an intensive care unit (ICU) and placed on a ventilator for respiratory support. The ICU nurses assessed the patient and found that she was unable to move her left side.

The surgeon ordered a CT scan of her brain, which showed she’d experienced a stroke. Within a few days, she died from multiple brain infarctions.

In the peer-reviewed journal Stroke, published by the American Court Association, a 2019 article outlines new evidence that suggests that infections, including sepsis can function as an acute trigger for stroke. The study found that infections and sepsis can increase stroke risk within a relatively short period of time.

Sepsis may cause stroke through a variety of potential mechanisms including atrial fibrillation, hemodynamic instability, coagulopathy (clotting disorders), systemic inflammatory response syndrome (SIRS), and prolonged inflammation.

The study identified independent risk factors for ischemic stroke after sepsis, including patient age of 45 years old or older, valvular heart disease of the heart valve, coagulopathy, high blood pressure (hypertension), peripheral vascular diseases, pulmonary circulation disorders, renal failure, and rheumatoid arthritis or collagen vascular diseases.

Surgeons and medical and nursing teams should be aware, as the study concluded, that it’s possible to identify patients at increased risk of stroke after sepsis. 

If you’ve been seriously injured because of post-operative complications, including infection, sepsis, or stroke in Texas, then contact a top-rated, experienced Texas medical malpractice lawyer for a free consultation about your potential case.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.


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