Penningtons Manches’ clinical negligence team has agreed the settlement of a claim against Arrowe Park Hospital (part of Wirral University Teaching Hospital NHS Foundation Trust), for an alleged failure to site surgical clips appropriately on a patient’s appendix stump after her appendix had been removed during keyhole surgery. The substandard care caused ischaemia and perforation of the appendix stump, resulting in sepsis and the need for further surgery.
The patient, a mother of two in her twenties, attended A&E in July 2012 with lower abdominal and back pain. A physical examination revealed tenderness with guarding in the lower right side of the abdomen – known as the “right iliac fossa”. The A&E doctor considered that the potential causes for her symptoms ranged from a urinary tract infection to appendicitis. She was therefore admitted into the surgical ward for further investigations that day.
After being diagnosed with appendicitis, she underwent keyhole surgery to remove the appendix two days following her admission. The surgery was undertaken by a surgical registrar and the patient was then transferred into recovery.
During the course of the following day, she experienced very severe pain which required strong pain relief, in the form of morphine. She was also nauseous and was noted to be ‘tachycardic’, which means she had an abnormally fast pulse rate. The surgical team was concerned about her symptoms and therefore a CT scan was performed. This confirmed findings of ‘minimal free fluid in the pelvis’ and the decision was taken to bring her back into theatre.
Further surgery was performed by a consultant and it became evident very quickly that the patient had suffered an ischaemic / necrotic perforation of the mid appendix stump between two ligatures (surgical clips), and had developed sepsis as a result. The consultant drew a diagram of the findings at operation in his notes, which illustrated a significant gap between the two surgical clips. In order to treat the perforation and sepsis, the patient required a midline laparotomy, which entailed a large vertical incision in the middle of her abdomen. Sadly, she was very unwell as a result of the sepsis that ensued and she required treatment in ICU. Understandably, this was a very frightening time and she was concerned about the impact that this would have on her two very young children.
She was eventually discharged home, but as a single mother struggled with caring for herself and her two daughters. Therefore, she had to rely heavily on her parents for help.
Understandably, she was concerned about the standard of care she received during her original procedure. She sought advice from a local firm of solicitors, and Penningtons Manches subsequently took over conduct of her case in early summer 2015.
An independent expert was subsequently commissioned, who was critical of the care and skill provided during the keyhole procedure. He believed that the re-operation notes clearly portrayed that the surgical clips were not appropriately sited during the first procedure given the findings of a ‘significant gap’ between the two clips. Leaving such a large gap cut off the blood supply on the retained stump, causing perforation and sepsis. Had the two clips been situated side by side without an intervening gap, the problems that ensued could have been avoided entirely.
Liability was fully disputed by the trust on the basis that the consultant’s operating notes could not be relied on as a true and accurate reflection of the findings at operation and it was alleged that the problems that the patient experienced arose as a result of a recognised and non-negligent complication. However, Penningtons Manches firmly maintained the patient’s position and proceeded down the court timetable. After much negotiation, the trust agreed to compensate her for the pain, suffering and financial loss sustained as a result of her negligent care.
Naomi Holland, a lawyer in Penningtons Manches’ clinical negligence team who ran the case to conclusion, comments: “Unfortunately, we deal with many cases involving delayed diagnosis of appendicitis which can have devastating consequences, including perforation of the appendix and sepsis. It is widely known that sepsis is very serious and it can prove fatal in the worst of cases.
“In this case, it was clear that our client’s appendicitis was diagnosed and treated early, but due to the alleged substandard performance of the surgery, she experienced unnecessary pain and suffering, needed further, more invasive surgery and had a prolonged recovery period. She continues to be affected by her significant scarring, which is a constant reminder of how things went very wrong for her, and wishes to highlight the issues arising in her care in the hope that future incidents can be avoided.”
If you or a family member have concerns about a case relating to the management of appendicitis, please contact the specialist team at Penningtons Manches.