Acute abdominal pain: when medical negligence is hard to stomach

Acute abdominal pain: when medical negligence is hard to stomach

Whether it’s crampy or achy, dull or sharp, everyone gets stomach ache – or abdominal pain – from time to time. Common tummy troubles such as gastric flu, constipation, excess gas, and irritable bowel syndrome are usually harmless and discomfort doesn’t generally last too long.

But if your stomach pain is of sudden onset, comes out of nowhere and feels nothing like you’ve experienced before, it may be a sign you have acute abdominal pain (AAP). This could be a life-threatening medical emergency if left untreated.

Abdominal pain is one of the top three reasons why patients attend A&E in the UK, yet only a few will have AAP. If your abdominal pain makes it difficult to function, it is important to trust your gut and seek urgent medical advice.

What is acute abdominal pain?

Acute abdominal pain is defined as being that which occurs suddenly and severely. Despite its name, your stomach isn’t always to blame. It can be caused by trauma, inflammation or obstructions to the various organs within your abdominal cavity, such as bowel, gallbladder, appendix or kidneys. Most cases of acute abdominal pain will be medical emergencies that require specific and urgent diagnosis, as well as immediate surgical treatment. Any delays to diagnosis and treatment can have grave consequences.

However, due to the sheer number of visceral organs which could be affected, and the presentation of symptoms being parallel to some gastroenteric conditions, a definitive diagnosis can be difficult to reach. Differential diagnosis is broad, covering a wide range of ailments such as (but not limited to):

  • Appendicitis
  • Pancreatitis
  • Bowel perforation or obstruction
  • Inflammatory bowel disease – Crohn’s, Ulcerative Colitis etc.
  • Peptic ulcer
  • Diverticulitis
  • Kidney stones or gallbladder complications
  • Ectopic pregnancy
  • Cancer
  • Sickle cell disease.

While location of pain may be an indicator as to the exact cause of acute abdominal pain, medical professionals should be aware of the varying signs and symptoms of each diagnostic group. Patients with peritonitis (infection to the abdomen wall lining) may lie still, while those with colicky pain caused by an obstruction will writhe around. Peritonitis may be aggravated by movement, while conditions like pancreatitis may be relieved by movement.

Some associated symptoms of acute abdominal pain are:

  • Vomiting
  • Lumps in the abdomen/groin
  • Change in bowel/urine habits
  • Fainting, dizziness, palpitations
  • Fever
  • Itching/rash
  • Weight loss

How is acute abdomen assessed?

On initial assessment, medical professionals should always ask if the patient is critically unwell – are they showing signs of sepsis or shock? This is when time is of the essence to ensure the patient receives immediate antibiotics and IV fluids to fight the infection before it becomes fatal.

Acute abdominal pain assessmentGenerally, assessment includes inspection to look for visible signs on the body, auscultation to listen to the abdomen’s four quadrants, percussion to tap the stomach to check for gas, and palpation to feel for masses or tenderness. Bruising around the belly button may be a sign of ectopic pregnancy, while shallow rapid breathing signals peritonitis.

Careful assessment is vital to reaching a differential diagnosis, but the condition of a patient with acute abdomen can change rapidly. So, it is important to monitor the patient’s condition. If red flags are highlighted at any stage of assessment, such as hypotension, impaired consciousness, altered bowel sounds, or signs of shock and sepsis, then immediate treatment will be required to prevent further harm or injury.

What amounts to medical negligence in acute abdomen cases?

Medicolegal pitfalls generally occur due to delays in diagnosis and treatment of acute abdominal pain. This could be because a physician failed to appreciate the severity of the illness or examine correctly and thoroughly; for example, a rectal or vaginal examination was not carried out when required. In turn, this may mean acutely unwell patients were not transferred to hospital quickly enough for appropriate treatment. Other examples of negligence in acute abdomen cases happen when there are failures in follow-up assessments or a lack of monitoring to check for changes in a patient’s signs and symptoms.

If the patient is female, particularly in women of child-bearing age, then the clinician should always presume the patient is pregnant until proven otherwise. Failure to investigate the possibility of ectopic pregnancy can prove fatal. Obstetrics and gynaecological history should also be assessed. Symptoms of acute abdominal pain can be caused by menstruation, contraceptive devices such as the coil, STIs and pelvic inflammation, or previous gynae surgery.

In some cases of acute abdomen, surgical intervention may be required to repair or relieve the symptoms. This can also increase the risk of further injury – such as perforated organs or internal damage caused by techniques like keyhole surgery – depending on the patient’s individual condition and the competence of the surgeon.

In any case, the physical and psychological effects often caused to patients who suffer from negligent practice of acute abdomen treatment are life changing.

Past cases of acute abdomen negligence

At Medical Solicitors, our team has vast experience of helping clients who have been affected by many classifications of acute abdomen. Here we will highlight the four main areas we receive enquiries for.

Appendicitis

The actual function of your appendix is still not known. But if it becomes painful and inflamed, otherwise known as an appendicitis, delay in diagnosis and treatment can lead to life-changing injuries.

The appendix is a continuation of the large intestine and appendicitis usually occurs when it becomes blocked by stool, foreign body or cancer, leading to bacteria, inflammation and pain. Around 40,000 people are admitted to hospital with appendicitis every year and if prompt care is given, recovery time will be reduced.

However, if treatment is not given within 36 hours of symptoms presenting, then the risk of the inflamed appendix bursting or perforating increases by 15 percent. This is where the danger lies, as infectious matter from the burst appendix may leak into the abdominal cavity leading to life-threatening peritonitis.

Appendicitis pain will generally be retained in the lower right quadrant of the abdomen and may worsen with coughing, walking or jarred movement. You may experience fever and loss of appetite as well as a swollen tummy. Sometimes, it may be confused or misdiagnosed as other less-serious conditions such as gastroenteritis, constipation, IBS or Urinary Tract Infections (UTIs). We have settled cases where a patient died from sepsis after her ruptured appendix was wrongly presumed to be an ovarian cyst. Another previous client lost her unborn child in the second trimester after vomiting caused by a burst appendix was repeatedly overlooked as a symptom of pregnancy. She was treated twice for sepsis while in an induced coma.

Looking for more information about appendicitis medical negligence claims? Our handy appendicitis guide may help.

Cholecystitis

Also known as inflammation of the gallbladder, cholecystitis usually requires surgical removal if gall stones have formed and are causing swelling, pain or infection. Laparoscopy (or keyhole surgery) is classed as the gold-standard of gall bladder removal due to its non-invasive nature.

However, it isn’t without its faults. One common complication and recognised risk of gallbladder removal is damage to the bile duct. It may be burned, pinched, or mistaken for the cystic duct (which attaches the gallbladder to the bile duct) and cut. Any of these scenarios would mean that corrosive bile would leak into the abdomen or other parts of the body and cause infection.

Injury to the bile duct is not always classed as a negligent act. However, clinical negligence occurs when there is a delay in diagnosis and treatment of such damage. Only between 10-30 percent of cases are discovered by the surgeon while they are operating; a large proportion of patients may not actively have symptoms picked up for weeks. But failure to recognise bile duct injury can result in serious conditions such as peritonitis, liver damage, and cholangitis (infection of gall bladder) which, if not treated quickly, can be life-threatening.

Treatment should be by way of surgical emergency, not conservative management, as we found in a case recently settled by solicitor, Miriam Bi, where a delayed reaction to a bile duct injury following gallbladder surgery proved fatal for a patient. Despite complaints of not feeling well with abdominal pain and vomiting, the patient was wrongly discharged from hospital. She developed sepsis and multiple organ failure which led to her death nearly a month after the surgery.

You can find other past cases of gallbladder medical negligence, as well as more information about diagnosis and treatment options, in our helpful gallbladder guide. In recent years, the use of robotics in laparoscopy has surged. But does it reduce the risk  of bile duct injury to patients? We recently looked at how keyhole surgery could be improved by technological advancements.

Ectopic pregnancy

The sight of two lines on a pregnancy test whips up many emotions. Elation, surprise, relief. But if the pregnancy is ectopic, the expectant journey can be frightening.

One in 90 pregnancies (around 1 percent) will be ectopic, whereby the fertilised egg implants outside the womb, usually in one of the fallopian tubes. This may happen due to various risk factors, including previous ectopic pregnancies, types of contraception, IVF fertility treatment, or tubal surgery.

Signs may be similar to those of a womb pregnancy, such as a missed period, breast tenderness and cramps. But main indicators of an ectopic pregnancy are when tummy pain is localised to one side, bleeding is watery and brown in colour, and referred pain occurs in the tip of the shoulder. The woman may not realise that she is pregnant if the bleeding started around the time of her expected period.

If the ectopic pregnancy is missed or not managed early, the fallopian tube can rupture, risking internal bleeding and fatalities. An hCG test will confirm whether pregnancy hormones are present. Other ways to detect the location of the embryo are a vaginal ultrasound and laparoscopy.

If an ectopic pregnancy is confirmed, patients may be offered what is called ‘expectant management’ where the woman’s condition is monitored on the basis the pregnancy will end naturally. However, clinicians should monitor carefully and look at the risks and benefits of all treatment options, including an injection to dissolve the pregnancy, or surgical removal via laparoscopy. Some patients may need to have one or both of their fallopian tubes removed to reduce the risk of future ectopic pregnancies. However, this will of course have adverse affects on fertility.

Usually, with prompt care and treatment, most women’s recovery following an ectopic pregnancy is straightforward. But the impact on mental health can be traumatic and you may wish to seek support from a counsellor. The Ectopic Pregnancy Trust has some great information and resources.

But the risk of morbidity increases with lack of awareness, failing to carry out a urinary pregnancy in all women of fertile age with pain, and not recognising that gastro-intestinal symptoms such as diarrhoea are sometimes a feature of ectopic pregnancy. We supported a family who lost their wife and mother during an operation to remove an ectopic pregnancy.

Perforated Bowel

Perforated bowel is where the bowel (or large intestine) is punctured either due to a medical condition or trauma. Medically, this could be a complication of conditions such as diverticulitis, inflammatory bowel disease, strangulated hernia, peptic ulcer disease or a lack of/poor blood flow to the intestines due to a blocked artery. However, bowel perforation can also be caused by trauma such accidental injury during abdominal surgery or gynaecological procedures.

Negligence occurs when signs are not promptly recognised, meaning potentially life-saving treatment to repair the bowel and prevent its contents leaking into the abdomen is delayed. If the perforation is caused during a medical procedure, it should be detected at the time of surgery and repaired immediately. If a patient suffers from medical conditions that increase the risk of bowel perforation, it should be presumed when they present with symptoms of acute abdominal pain. A blood test is usually carried out to check for infection or blood loss. An X-ray may also be performed to check for air under the diaphragm – a major sign of perforation.

If diagnosis is prompt, an ‘end-to-end’ repair may be possible: the damaged part of the bowel is removed and the ends tied together. However, in many cases, more invasive surgery will be required to create a stoma to enable your bowels to recover. While temporary, further surgery is needed to reverse the stoma. But sometimes this is not possible.

Many people affected by perforated bowels are women who have had gynaecological procedures. Some examples include a woman who had a perforated uterus and bowel following endometrial ablation where an undetected plastic sheath was left inside her abdominal cavity in error. Another had a delay in diagnosis of Ogilvie’s syndrome (a condition which acts like an obstruction of the colon), following the birth of her child by Caesarean section.

For more information about the risks of delayed diagnosis if your bowel is perforated, see our guide here which looks at treatment options and the complications of such procedures.

Contact us

Delays in providing appropriate medical care can affect all areas of life, but particularly how quickly and successfully a patient recovers. In turn, this can often lead to financial repercussions for the patient, and their family who are financially dependent upon them, or rely upon them for care and support at home. If you think you have a case to make a medical negligence claim based on delayed diagnosis of any condition, our specialist team can look into your case on a No Win No Fee basis. Call our Sheffield office on 0114 2507100 or request a call back through our enquiry form.

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