Failure to treat perianal abscess leads to multiple surgeries

Mrs A, was in her late 60s when she attended her GP on 29 July with a one week history of worsening anal pain and discharge.  A pilonidal sinus (a small hole or tunnel in the skin filled with fluid or pus, causing the formation of a cyst or abscess) and haemorrhoids were noted and the GP wrote to the hospital requesting that they review Mrs A urgently.

On 31 July Mrs A spoke to her GP complaining of severe chest pain and was admitted by ambulance to Eastbourne General District Hospital.  She was seen in A&E where a junior doctor considered she required IV antibiotics and review by the surgical registrar.  However, she was then seen by the registrar who said that incision and drainage was not required, and the plan was to send her home with oral antibiotics.  However, Mrs A was discharged without antibiotics.

The pain worsened overnight and on 1 August Mrs A collapsed.  She was taken to the Conquest Hospital in Hastings, where an indurated left perianal abscess was noted.  The abscess was drained and she was discharged the following morning without antibiotics or painkillers.

Following several days at home, she returned on 5 August with increasing pain, crepitus (crackling sensation in the lungs due to the presence of air in the subcutaneous tissue) and spreading cellulitis (bacterial skin infection) was noted, with a need for urgent debridement (removal of the damaged tissue).  She was prescribed multiple intravenous (IV) antibiotics and between 5 August and 28 August underwent nine separate procedures on the abscess.

She was discharged on 5 September 2014 and eventually underwent surgical repair 15 months later.

The repair was successful and Mrs A is now essentially symptom free.

Oliver Chapman was instructed and obtained a report from a consultant surgeon which was supportive.  He considered that Mrs A’s treatment fell below an acceptable standard, and was negligent, in the following respects:

On 31 July Mrs A’s temperature was raised and she was tachycardic.  Examination revealed a 5cm indurated perianal abscess, which was tender.  She had raised inflammatory markers in her blood.  She was discussed with the surgical registrar who indicated that she was not for incision and drainage, but instead for antibiotics and review.  It was the expert’s opinion that given her presenting symptoms it was mandatory that the surgical registrar reviewed Mrs A.  Failure to review represented a breach of duty.

If a review had taken place, Mrs A’s condition would have mandated admission and drainage of the abscess.  The fact that Mrs A was discharged, rather than admitted represented a breach of duty.

Mrs A was sent home without antibiotics.  She should have received IV antibiotics during 31 July and overnight.

She should have been discharged on 2 August with a five day course of oral antibiotics.  A failure to discharge without antibiotics represented a breach of duty.  Had Mrs A received 48 hours of IV antibiotics, followed by five days oral antibiotics, it would have changed the degree of her sepsis.

In addition, there was a failure to review Mrs A with the results of an MRI scan which had taken place in November 2014 and revealed a fistula (abnormal channel or passageway) requiring urgent treatment.

Fortunately Mrs A experienced a good recovery.  We wrote a letter of claim and made an offer of settlement.  The case eventually settled for £20,000.

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