Clinical Negligence

Appendix surgery leads to major abdominal injuries

Miss P, who was in her thirties, was admitted to Medway Maritime Hospital with right sided abdominal pain and PV bleeding.  On admission she was tender in the right iliac fossa, but her observations and blood biochemistry were normal.

The following day a diagnostic laparoscopy (keyhole surgery) was performed, in the course of which the appendix was removed and ‘misplaced’.  The laparoscopic procedure was converted to a laparotomy (an open procedure) in order to locate and retrieve the appendix.  This was not straightforward and surgery lasted for over four hours.  During the procedure Miss P momentarily regained consciousness and heard someone say ‘we are going to lose her’ before she lost consciousness again.

She was subsequently bedbound and, two days later, she suffered a pulmonary embolism and thereafter required anticoagulants for six months.

In the post operative period Miss P developed an infected wound which required VAC dressings and antibiotics.  She was discharged about three weeks later with ongoing wound infection and dehiscence requiring extensive ongoing treatment.  She returned to work about six months later once the wound had healed and the cellulitis had resolved.  However, shortly after an incisional hernia was noted.

The trauma to her abdomen resulted in a loss of core stability and weight gain and the Miss P developed lower back pain.  She was unable to exercise, became more sedentary and, over the course of about 18 months, gained 9.5kg.

She then presented at hospital complaining of chest pain and breathlessness.  A further pulmonary embolism was diagnosed.  About two years following surgery, she was advised that she required surgical intervention to address her unsightly scar, apron overhang and two incisional hernias but, at that stage, her obesity rendered her an unsuitable candidate for such surgery.

We were instructed by Miss P on a conditional fee agreement basis and obtained expert reports from a consultant general surgeon, chest physician and psychiatrist.  Court proceedings were issued and proceedings were served in which we argued that the defendant’s negligent decision to operate, first antagonised by the negligent misplacement of the excised appendix, resulted in significant injury, and ongoing loss, summarised as follows:

Abdominal injuries

Miss P had suffered:

•    An unnecessary laparoscopy converted to laparotomy.
•    A 21 day hospital stay during which she developed extensive wound infection and dehiscence.
•    Following discharge, ongoing wound infection/dehiscence lasting about five months.
•    An unsightly large midline laparotomy scar across the umbilicus.
•    In the region of the laparotomy wound, measuring 10cm x 5cm, persistent scar tissue and further swelling around the peri-umbilical region.
•    Induration of the lower part of the laparotomy wound associated with an overhang of the skin and subcutaneous tissue on either side.
•    Measuring 10cm x 6cm, a symptomatic incisional hernia around the umbilical region which is tender to touch and causes discomfort on mobilisation.
•    Significant embarrassment at the appearance of her abdomen.
•    Intermittent sharp pain in her lower abdomen around the side of her hernia with abdominal bloating associated with incisional hernia.

Expert evidence was that intra abdominal adhesions would develop and that Miss P had a 5% to 10% lifetime risk of developing complications such as bowel obstruction and chronic abdominal pain.

She now required further extensive abdominal surgery involving:
•    Bariatric surgery to assist with weight loss.
•    Subsequent abdominoplasty coupled with an abdominal wall reconstruction/mesh repair to address her unsightly scar, apron overhang and two incisional hernias.

Pulmonary embolism
Miss P has suffered two pulmonary embolisms resulting from the index surgery and now requires lifelong anticoagulants.

Respiratory compromise
Miss P suffered 20% respiratory disability underpinned by asthma, obesity and anxiety related to hyperventilation.  It was her case that 10% of that compromise related to hyperventilation which had developed as a consequence of the index surgery.  3% was due to weight gain experienced following that surgery.

Psychiatric injury
The complications of the index surgery had resulted in Miss P developing Post Traumatic Stress Disorder and depression of moderate severity.

In its defence the defendant admitted breach of duty in respect of the misplacement of the appendix and, in terms of causation, that the laparotomy, incisional hernia and adhesions would have been avoided.  However, the defendant denied that:

a.    it was negligent to proceed to surgery without a gynaecological opinion as there were enough signs to justify surgery and that the appendix is often found to show no signs of disease upon removal; and
b.    the first pulmonary embolism resulted from the claimant’s alleged incapacity prior to surgery.

The defence made no reference to the second pulmonary embolism and did not respond to Miss P’s allegations of psychiatric injury.

The defendant thereafter released two interim payments of £15,000 and a stay was ordered to allow the Miss P to undergo treatment.

Miss P then underwent bariatric surgery on a private basis.  The incisional hernia was reduced and a temporary repair effected pending weight loss sufficient to allow a formal abdominal wall reconstruction to go ahead.  She also received CBT/EMDR for treatment for her ongoing psychological injuries.

Miss P was thereafter keen that her case settle leading to the parties negotiating and agreeing a settlement of £100,000, which provided moneys to fund further abdominal repair.

Oliver Chapman specialises in clinical negligence cases.  If you would like to ask Oliver Chapman a question about a potential case, or if you have a general query about any clinical negligence, contact Oliver Chapman at Thomson Snell & Passmore solicitors on 01892 701234 in confidence.

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