Successful settlement for surgical injury
Our medical negligence team recently achieved settlement of a claim where our client’s bowel was injured during a hysterectomy.
KP was booked in for a total hysterectomy and bilateral salpingo-oophorectomy. The operation was carried out on Tuesday 13th February 2018. It was complicated by dense adhesions and the surgeon was unable to remove KP’s cervix. The plan was for discharge home on 15th February. The day after surgery, KP was complaining of abdominal pain and swelling. On 15th February, she developed tachycardia. The skin of her abdomen was shiny, warm and discoloured.
On 16th February, a diagnosis of possible infection was made and KP was prescribed oral antibiotics. She was seen by a surgeon later that day, who noted that her abdomen was tender with guarding, and there was a tense and tender area of cellulitis around the abdominal wound. Blood tests showed abnormal renal function consistent with Grade 1 Acute Kidney Injury. Arrangements were made to transfer KP to a different hospital that day.
On examination in A&E after she had been transferred, brown fluid was running from the left side of KP’s wound. The lower abdomen was tense and tender and the skin hot and erythematous. KP was started on IV antibiotics. She was seen by a consultant general surgeon, who noted cellulitis and oedema, draining purulent discharge and haematoma. The wound was opened and 50ml purulent discharge drained under pressure. The wound was packed with a plan for surgical washout the following day.
Late on 17th February 2018, KP underwent surgery for incision and drainage of her abdominal abscess. During the procedure, an injury to KP’s small bowel was identified. A lower midline incision was performed and the bowel was repaired by stapled anastomosis. The lower abdominal wall was noted to be incredibly weak and it was not possible to close the wound. A VAC dressing was applied. Subsequent histological examination of the operative specimen showed necrosis in the area of the bowel perforation. A nasogastric (NG) tube was inserted and, on 22nd February, KP was started on total parenteral nutrition, in view of the likelihood of prolonged paralysis of her bowel. A CT scan demonstrated probable adhesional bowel obstruction. On 25th February, the NG tube was removed and KP underwent a trial without catheter. By 26th February she was noted to be eating small amounts of solid food and total parenteral nutrition was stopped on 27th February.
As a result of the negligence KP had to endure a much more prolonged recovery, required additional care and support for longer than would otherwise have been the case, and had to take additional time off work.
KP was discharged home on 1st March 2018 with the VAC dressing in situ and was prescribed 4 weeks of oral antibiotics. The VAC dressing remained in place until 12th April. She required support with dressing changes from the District Nurses until 11th May. As a result of the requirement to undergo significant additional surgery, KP has been left additional scarring. KP is particularly troubled by this scarring and the appearance of her abdomen. The midline laparotomy scar was left to heal by secondary intent when it could not be closed following repair of KP’s bowel injury. This has left a deep, vertical cleft in KP’s abdomen, which is visible through clothing. The abdominal area either side of the scar is uneven, with one side larger than the other. KP is extremely self-conscious and the scar inhibits her from socialising, exercising and forming romantic relationships. To improve the appearance of her scar, KP will require up to two additional surgical procedures. In addition to her physical injuries, KP has also sustained psychiatric injuries, namely, Post-Traumatic Stress Disorder and a Depressive Episode of Mild Severity.
Liability in this case was admitted at an early stage by the Defendant. We obtained condition and prognosis evidence from a gastrointestinal surgeon, a plastic surgeon and a psychiatric expert. Settlement was reached in the sum of £67,500.