Lethal Hemorrhage Following Laparoscopic Cholecystectomy Complicated with Medicolegal Issues

Abstract

This is a case study of unexpected death after laparoscopic cholecystectomy for acute calculous cholecystitis, complicated with medicolegal issues including chronic methamphetamine use and alleged medicolegal malpractice. The deceased underwent a laparoscopic cholecystectomy following acute calculous cholecystitis, and died on the fourth day after the surgery. Postmortem examination revealed massive peritoneal hemorrhage and the cystic artery on the surgical site was cauterized but unligated. Histopathology of the gallbladder revealed acute inflammation due to gall stones but also ischemic change. As the investigation progressed, a history of chronic methamphetamine use was discovered, however, acute methamphetamine toxicity was excluded by toxicological test. Thus, we suggest forensic considerations based on a review of the literature in the interpretation of the pathology of the gallbladder, the unligated cystic artery and cholecystectomy, and chronic methamphetamine use.