We acted for a 50-year-old gentleman who sustained injuries following a Hospital’s failure to recognise that he was suffering from post-operative bleeding following an emergency appendectomy.
What went wrong?
On Christmas Day our Client was referred by his local Out of Hours service to the Hospital for suspected appendicitis. At lunch time on Boxing Day, he underwent a laparoscopic appendicectomy (surgical removal of his appendix).
Following surgery, our Client was observed regularly until later that evening, when there was a 100-minute gap between observations.
During that time, unbeknown to the Hospital staff (because of the lack of observations) or our Client, he had developed a serious post-operative bleed.
As a result of extensive blood loss, our Client’s heart stopped beating and he required a cycle of cardio-pulmonary resuscitation (CPR), before being rushed back into theatre for an emergency laparotomy to treat his intra-abdominal bleeding. During surgery, a haemoperitoneum (a collection of blood in the peritoneum) of 1-2 litres was found, with bleeding coming from his inferior epigastric vessel.
In the course of this procedure, our Client again became unstable and a cardiac arrest call was put out.
Following the emergency laparotomy, our Client was admitted to the Intensive Care Unit (ITU). He was intubated as he was acidotic and hypothermic despite fluid resuscitation.
Just over a week later, our Client was diagnosed with hospital-acquired pneumonia (HAP), but was able to be discharged a few days later on oral antibiotics.
Unfortunately, on a week after his discharge, our Client had to be re-referred to hospital by his GP due to a deterioration in his condition. A CT scan was performed, which confirmed that there was a 10 x 10 x 17 cm subcapsular collection of blood (a ‘subcapsular haematoma’) beneath his spleen, which had to be surgically drained. Following this procedure, he was admitted to ICU, where he remained until for 5 days, before being sent to a ward to convalesce for a further two weeks.
A year later, our Client had to be re-referred to the Defendant Hospital because of ongoing upper left abdominal pain.
Our Client was not saying that there was negligence in respect of the performance of the original surgery to remove his appendix (the laparoscopic appendicectomy). He accepted that damage to the inferior epigastric arteries may represent a non-negligent complication of laparoscopy in some patients.
However, where there has been an epigastric arterial bleed during surgery (as there was here), the indication is for close (hourly) observations and monitoring post-operatively. The gap of 100-minutes meant that the bleed was missed and treatment not obtained until our Client was so unwell that he required CPR.
He further alleged that the negligence also had the following consequences:
- Whilst he accepted that he would have required re-admission to hospital on 13 January 2013 in any event due to a discharging wound, but he would not have required the laparotomy of 16 January 2013 if it had not been for the negligence. The discharging wound would have been treated conservatively. The laparotomy was indicated because of the sub-capsular haematoma. Accordingly, it was his case that the laparotomy of 16 January 2013 was a consequence of the negligence.
- The need for a second laparotomy increased the length and deterioration of the first laparotomy scar. One third of the scarring can be attributed to the second laparotomy.
- As a result of the need for a second laparotomy, he sustained a large incisional hernia. If it had not been for the second laparotomy, he would have been unlikely to have developed an incisional hernia (the risk of a hernia is four times greater in a second laparotomy than in a first laparotomy).
- As a result of the need for a second laparotomy, he developed ongoing left-sided abdominal pain and neuropathic wound pain. He accepted that he would probably have had some minor and intermittent wound pain after a first laparotomy, but this would have been temporary and would have been managed by analgesia for three months, and would have abated by six months post-surgery.
- As a result of the need for a second laparotomy, our Client has increased future risks of complications, including a 20% lifetime risk of adhesive small bowel obstruction (as compared with 10% if he had undergone only one laparotomy); 2% lifetime risk of open adhesiolysis (as compared with 1% if he had undergone only one laparotomy); 20% lifetime risk of recurrence of hernia (as compared with 5% if he had undergone only one laparotomy).
- As a result of the CPR he developed generalised arm pain in his left (non-dominant) arm.
- He suffered flashbacks, nightmares and other psychological symptoms arising from his memory of events, which would have been avoided.
As a consequence of the negligence, our Client sustained the following injuries:
- A cardiac arrest and the need for CPR
- A Subcapsular Haematoma
- The need for a second laparotomy
- A very large wide-mouthed incisional hernia which requires repair (this will involve an in-patient stay of 5-7 days and a convalescence period of 6 weeks to 3 months and carries further risks)
- Ongoing left-sided abdominal pain and ongoing neuropathic wound pain
- Arm pain in his left (non-dominant) arm
- Post-Traumatic Stress Disorder last six months, with an Adjustment Disorder persisting after this
- An impact on his ability to return to heavy manual work
The Defendant’s response
The Defendant admitted that the 100-minute gap between observations led to the bleed being missed for longer than it ought to have done and that CPR (and all its complications) would have been avoided with proper care. Specifically, they admitted that:
- Without the 100-minute gap, our Client’s haemorrhage would have been identified by the treating clinicians. Abnormal observations would have resulted in the surgical team attending our Client with urgent priority. The significance of increasing tachycardia, hypotension and abdominal pain would have been realised. Appropriate resuscitation would have been undertaken.
- On the balance of probabilities our Client’s cardiac arrest would have been avoided.
- The sub-capsular haematoma would have been avoided.
- Our Client would not have required surgery to deal with the haematoma.
- Our Client would not have required a referral for upper left quadrant pain in January 2014.
Court proceedings were issued, but we were able to agree an out-of-court settlement with the Defendant in the sum of £155,000 without the need to go to Trial.
S J Edney solicitors obtained compensation of £155,000 for this client in 2018