Clinical Negligence

Obstetrician misses rectal tear causing recto-vaginal fistula

Ms Q gave birth to her first child at Maidstone Hospital, Kent via a forceps delivery and required an episiotomy (surgical cut to the opening of the vagina).  Unbeknownst to her at the time she also suffered a rectal tear which was not diagnosed or repaired by the obstetrician following the birth.  She was discharged from hospital five days after the birth but was returned to hospital the next day when the midwife noted she was passing faecal matter through her vagina.

Ms Q was diagnosed with a recto-vaginal fistula (an abnormal connection between the rectum and vagina) and she was referred to St Mark’s Hospital.  She was prescribed antibiotics and discharged six days later.

She saw the consultant at St Mark’s the following month and underwent an examination under anaesthetic (EUA) with a defunctioning colostomy (surgical procedure that brings one end of the large intestine out through the abdominal wall).  Unfortunately five months later Ms Q developed a perineum infection and required two further EUA procedures as well as a procedure to treat granulation tissue with silver nitrate.

During the third EUA procedure (one year after the birth) it was noted that there was now a fistula from the anus to the perineum.  Ms Q underwent curettage of the external opening of the fistula and an Ethibond suture was used as a seton (a procedure to run a surgical-grade cord through the fistula tract so that the cord creates a loop that joins up outside the fistula).

Unfortunately two months later Ms Q was readmitted and required a further EUA with closure of the colostomy.  Ms Q was told she would need further surgeries in the future to close the fistula.  However Ms Q wanted to have further children and so the procedure was placed on hold.  Ms Q was advised if she wanted further children she should do so without delay.

Ms Q sufferd with faecal incontinence which she understandably found extremely distressing.  Significant pressure was placed on Ms Q and her partner, who required counselling because of the strains on their relationship.  Ms Q also found it extremely difficult to socialise because of her incontinence.

Ms Q suffered a loss of independence and dignity which had dramatic effect on her confidence and emotional wellbeing, both of which contributed to her being unable to return to work.  Unfortunately an employment tribunal followed thereafter.  Ms Q had previously been a highly earner with a promising career.

Unfortunately matters were only exacerbated when Ms Q later lost her second baby.

Fiona Follis was instructed to act on behalf of Ms Q and obtained reports from various experts including an obstetrician, colorectal surgeon and a psychiatrist.  It was argued that, had the rectal tear been diagnosed at the time of the delivery and repaired, it was likely Ms Q would only have required a four or five days in hospital with antibiotics and stool softeners.  She would have avoided developing a fistula and the associated surgeries and complications thereafter, as well as her psychiatric injury.

Fiona successfully negotiated an out-of-court settlement of £725,000 to compensate Ms Q for her pain and suffering and to pay for her future surgery needs on a private basis.

Fiona specialises in obstetric cases.  If you would like to ask Fiona a question about a potential case, or if you have a general query about any personal injury, contact Fiona Follis at Thomson Snell & Passmore solicitors on 01892 701286 in confidence.

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