Total small bowel resection in a patient who refused surgery: why did the surgeon do it?

Gastric surgery may result in internal herniation of bowel, weeks to years after the initial surgery and can result in rapid onset of death if not promptly treated. We present a case in which a patient with this complication underwent surgery despite his clear refusal of surgery. The patient had a remote history of gastrectomy for malignancy. Several years later, he presented with the feared complication of an internal herniation to a local hospital. The initial surgeon recommended urgent operation to correct this. However, the patient refused. When he became comatose, the surgeon performed surgery, but the patient's condition continued to deteriorate. The surgeon performed further surgery, eventually removing the entire small bowel, leaving nothing connecting the esophagus or effluent from the liver and pancreas. Although this was a fatal situation, he had temporary recovery sufficient to understand the nature of his prognosis and survived several weeks.