The patient was middle-aged with a history of obesity, hypertension and rectal cancer diagnosed earlier this year.He underwent robotic-assisted abdominoperineal resection.Approximately 1 hour after surgery while in the post-anesthesia care unit he was noted to be unresponsive and pulseless.At that time cpr was initiated.Noted to be in pulseless electrical activity (pea) arrest.Return of spontaneous circulation (rosc) was obtained after two rounds of cpr.The team was concerned for an acute myocardial infarction.The patient was taken to catheterization lab for intervention, and heparin and aspirin were administered for a presumptive coronary thrombus or pulmonary embolism.No evidence of acute blockage of coronary arteries was noted, and repeat hemoglobin measurement showed severe anemia and volume resuscitation with blood products and fluids was continued.An emergency exploratory laparotomy was performed, and 3 to 4 units of blood were noted in the abdomen which was then extensively packed to control the bleeding.However, despite control of the intraabdominal bleeding and transfusion of blood products, return of spontaneous circulation was not achieved.The injuries were deemed nonsurvivable.The patient expired.Subsequent autopsy reveal a patient inferior mesenteric artery where sealant had been used intraoperatively.
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