Fatal multi-organ failure following vascular and bowel injury during a surgery for hip fracture: A case report

Introduction: Deaths following major orthopaedic procedures in patients with significant comorbidities often raise medicolegal concerns regarding whether post-operative complications represent unavoidable surgical risk or negligence.
Case Presentation: This report describes a 56-year-old woman with long-standing multiple medical conditions, such as diabetes mellitus, hypertension, dyslipidaemia, and obesity, who sustained an acetabular fracture and underwent open reduction and internal fixation. During surgery, she developed an inadvertent external iliac artery injury resulting in torrential bleeding, which was dealt with by repairing it with a prosthetic graft. A concurrent ileal tear was repaired by end-to-end anastomosis. Despite appropriate operative management and intensive post-operative care, she developed progressive renal, hepatic, and respiratory failure and succumbed 10 days later. Forensic autopsy revealed intact vascular graft and bowel anastomosis, absence of rebleeding or leakage, and generalized pallor of most internal organs with loss of cortico-medullary differentiation of both kidneys, consistent with multi-organ failure secondary to prolonged hypoperfusion.
Conclusion: This case highlights the essential role of a forensic autopsy in differentiating recognized complications from negligence. Correlation of operative records with autopsy findings ensures accurate medicolegal interpretation and fairness to both clinicians and families.