Back in 2021, the founder of Kim San Leng kopitiam Hoon Thing Leong, passed away aged 72.
After an inquiry into his death, a state coroner has ruled it a medical misadventure.
He noted that Mr Hoon may have likely bled from punctures to his liver as a result of a percutaneous liver biopsy.
The Straits Times (ST) reports that on 10 May, state coroner Adam Nakhoda revealed that Mr Hoon was diagnosed with coronary artery disease.
Source: Standard Chartered Singapore on Facebook
As such, he had a pacemaker implanted on 7 Sep 2020.
On 5 Mar 2021, Mr Hoon suffered a bout of subdural haemorrhage, i.e. bleeding in the area between the brain and skull.
He underwent surgery for the haemorrhage in Mount Elizabeth Novena Hospital, where staff discharged him four days later after he felt more relaxed.
However, Mr Hoon returned to the hospital, and an assessment revealed a low platelet count. Medical staff also took bone marrow samples from him.
On 15 Apr 2021, a computerised tomography scan at Singapore General Hospital (SGH) showed that Mr Hoon had a cirrhotic liver.
Mr Hoon had decided to seek further treatment at SGH the day before under Professor William Hwang.
After the scan, the professor felt magnetic resonance imaging would help with his diagnosis, but his pacemaker made this difficult.
He told Mr Hoon that a liver biopsy to investigate lesions in the liver would be ideal as the tests had only revealed the cirrhosis.
Unfortunately, his low blood count also increased the risks of such a biopsy. As a result, Prof Hwang recommended a bone marrow biopsy, which took place on 21 Apr 2021.
The biopsy results were normal, and Prof Hwang said a liver biopsy was necessary to gauge the presence of underlying cancer.
On 28 Apr 2021, Dr Alexander Tan began the biopsy at around 4.20pm. The state coroner said he had performed it competently and appropriately.
Mr Hoon’s condition was also stable when staff transferred him later to the general ward.
However, he was breathless and slightly drowsy at around 1.30am the day after. With his condition deteriorating, he was submitted to medical intensive care and passed away at around 10.30pm on 29 Apr 2021.
According to the autopsy, his peritoneal cavity, the space within the abdomen containing the intestines, the stomach, and the liver, had 4,000ml of dark liquid blood and 475g of dark red blood clots.
The anterior surface of the liver’s right lobe adjacent to a blood vessel also contained a puncture mark. However, there was no evidence that any blood vessels had undergone perforation.
“I found that it was probable that Mr Hoon had bled from the punctures to his liver caused by the percutaneous liver biopsy,” the coroner said.
“This was a known complication of a percutaneous liver biopsy, and the presence of [lymphoma] could have contributed to the likelihood of bleeding.”
He added that SGH’s reaction and treatment to Mr Hoon’s collapse was timely and appropriate.
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Featured image adapted from Standard Chartered Singapore on Facebook and Google Maps.
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