Negligent post operative care

Mrs N had a longstanding history of gynaecological treatment which included a hysterectomy, an anterior vaginal prolapse repair and a posterior vaginal prolapse repair. Following this surgery she was prescribed Vagifem pending rectocoele (bulging in the front wall of the rectum) and vault repair.

She was later admitted to Hospital as an emergency case with small bowel loops prolapsing through a ruptured vaginal vault. She underwent emergency surgery the same day to repair the vault.

Unfortunately, Mrs N experienced a difficult post-operative recovery and she was not reviewed by the surgical team for a number of days. She continued to complain of abdominal pain, nausea and vomiting which did not resolve.

She was noted to have a hard firm lump at the right port site. The following day this was noted as a haematoma and had increased in size. The impression was that this was likely a post-operative ileus (post-operative lack of movement leading to a potential blockage). Mrs N continued to suffer nausea and vomiting. She was unable to eat or drink and had had no bowel movements since her surgery. She consequently required the insertion of a PICC line (a catheter for IV antibiotics, medication and nutrition) to assist with nutrition (TPN).

The mass at the right port site was suspected to be a hernia and an ultrasound scan was performed which confirmed this. A CT scan revealed an obstruction of the small bowel secondary to a strangulated right spigelian hernia (a hernia developing in the muscles of the abdominal wall). Mrs N underwent an open repair of the strangulated spigelian hernia at the right port site with small bowel resection and re-anastomosis (reuniting). Mrs N experienced a slow recovery in bowel function.

It was Mrs N’s case that she should have been reviewed by a senior surgical clinician the day after her surgery. A CT scan should have been performed earlier due to the symptoms of persistent right iliac fossa swelling, pain, nausea and vomiting. The hernia would have been identified and surgical repair would have taken place sooner. The bowel would not have been infarcted at that stage and would have been reduced without the need for bowel resection, and open surgery, and therefore would have suffered less significant abdominal scarring. She would not have required the insertion of a PICC line and TPN. Mrs N would have recovered within 4 to 5 days and would have been discharged sooner.

Settlement negotiations commenced and Mrs N received payment of damages.