What happened, in summary

A 79-year-old man with repeated black stools was diagnosed with poorly differentiated gastric adenocarcinoma. He also had significant heart and lung disease and a prior cerebral infarction. He underwent total gastrectomy with lymph-node dissection and Roux-en-Y reconstruction.

Nine days later, he suddenly developed severe right-upper-abdominal pain, fever and signs of liver and kidney dysfunction. CT showed a swollen thick-walled gallbladder, fluid in the abdomen and bowel obstruction. By the following morning he had developed septic shock. Emergency surgery found a markedly enlarged gallbladder with gangrenous areas. Because dense postoperative adhesions made complete removal unsafe, most of the gallbladder was removed and antibiotics were continued in intensive care.

His course remained severe. He developed worsening jaundice, followed by a serious lung infection with resistant organisms and fungi, and then chronic heart failure. He died 42 days after surgery from severe multiple-organ dysfunction and septic shock related to these postoperative complications.