The Claimant, a 60-year-old woman, was awarded £325,000 in relation to a delay in diagnosis and treatment of a large peri-hepatic collection surrounding the right lobe of the liver with pockets of gas within following routine elective laparoscopic cholecystectomy.
The Claimant had undergone initial surgery on 9 March 2018 and was discharged the same day. She was re-admitted on 13 March 2018 with abdominal pain. Despite CT imaging and ongoing deterioration, the Claimant was not taken back to theatre until 30 March 2018. She required seven more surgical interventions and spent a prolonged period in ICU.
Claimant - Female; 56 years old at date of the incident; 60 years old at date of settlement (“C”)
Clinical Negligence: The Claimant was referred under the care of the surgical team at Glan Clywd Hospital in relation to gallstones. She was initially investigated in 2017 following referral by her GP. She was admitted as a day case for elective laparoscopic cholecystectomy on 9 March.
Risks of surgery included infection, bile leak, injury to bowel/bladder, DVT/PE. The surgery was uneventful and she was discharged.
She was re-admitted via A&E on 13 March having developed sudden worsening of abdominal pain, mainly RUQ, constant and radiating to right shoulder, worse with movement and breathing.
On 15 March, a CT abdomen and pelvis demonstrated a “large peri hepatic collection surrounding the right lobe with pockets of gas within “CBD is mildly dilated to 9mm and there is minimal intrahepatic duct dilation. No obstructing calculus is seen however”. A CT guided drainage was booked for later that day during which 540mls of bile was drained. Further guided drainage took place on 16 March and thereafter conservative management took place.
On 22 March, the Claimant’s MEWS increased to 4, which were suggestive of signs of sepsis and on 23 March an ultrasound demonstrated a subhepatic fluid collection 2 x 8 x 8.2cm. However, it was not until 30 march that the Claimant was finally taken to theatre where she underwent a laparoscopy and peritoneal lavage was carried out. Through the infraumbilical port “copious bile stained fluid” was aspirated. A diagnosis of severe biliary peritonitis with large fluids collections in separate areas” was made.
She remained in ITU until 30 April 2018 and thereafter commenced physiotherapy. She was eventually discharged on 15 May 2018.
When reviewed in December 2018, the Claimant had a large incisional hernia which was causing discomfort especially after eating. It was explained that the hernia could be fixed but would be high risk for adhesions, chronic pain and failure and would need compartmental separation to fix.
The stent was finally removed on 28 May 2019.
Breach of Duty
It was the Claimant’s case that no reasonably competent general surgeon would fail to undertake a return to theatre. In theatre, they would have carried out a copious washout and leave drains to the site of the biliary leak under the circumstances that were present on 24 March 2018. There were preliminary signs of sepsis that could have been adequately treated at the time.
The Defendant admitted that following the results on 24 March 2018, the failure to undertake operative intervention constituted a breach of duty of care.
Causation
But for the Defendant’s breach of duty, the Claimant would have been treated successfully with a laparoscopic approach and surgical drains. She would have avoided admission to the Intensive Care Unit, a laparotomy, tracheostomy, the formation of a laparostomy and the consequent abdominal wall failure. The Claimant faces lifelong potential complications and her laparotomy and a requirement for further treatment for her abdominal wall failure that would have been avoided had she been taken back to theatre in an appropriate time frame. The Claimant has suffered psychological injury as a result of the Defendant’s breach.
Expert evidence was obtained from a General Surgeon, Psychologist, Care and OT.
Injuries: The Claimant suffered extensive injury and scarring. She developed incisional hernia, suffers extremely loud bowel sounds (borborygmi), which she finds embarrassing, and her mobility has been compromised. The Claimant is self-conscious about her abdominal wall failure and large incisional hernia. She has to wear an abdominal binder. The injuries have affected her body image significantly which has impacted her sexual relationship with her husband.
Effects: She is unable to undertake any significant activities of a domestic nature, she has difficulty using the stairs and difficulty showering. She fatigues easily. She is unable to eat certain foods, she has been unable to return to work.
Liability: admitted by the Defendant
Out of Court Settlement: £325,000 total damages
Body Part: Abdomen, Bowel
Condition: Severe abdominal injury causing impairment of function necessitating temporary colostomy, psychological injury
