Perforated Bowel Claims
A perforated bowel is a medical emergency and complications caused by it can be critically dangerous if not treated with urgency. This guide will help you understand what the causes of a perforated bowel are, the signs and symptoms to be aware of, treatment options, and what constitutes negligent practice surrounding diagnosis.
What is a perforated bowel?
Your gastrointestinal tract is the route your food takes all the way from your throat. It is processed in your stomach where it empties into your small intestine before going into your large intestine (your bowel) before exiting from your rectum. If a hole forms in your bowel, it is called a perforated bowel.
Why does this happen?
Perforated bowel can either be due to medical condition or from trauma. Medical conditions which may cause perforated bowel include Diverticulitis, Ulcerative Colitis, Crohn’s disease, strangulated hernia and peptic ulcer disease. Also, a lack of blood flow or poor blood flow to the intestines due to a blockage in an artery can lead to perforation.
The causes discussed above are natural causes, because of disease processes. But perforation can also be caused by trauma, such as accidental injury to the bowel, by a surgeon, during abdominal surgery. In addition, perforation can occur during gynaecological procedures, such as hysteroscopy, if the surgeon inserts equipment such as a probe to deep into the womb.
What are the signs and symptoms of a perforated bowel?
Signs of a perforated bowel may include severe abdominal pain, chills, fever, nausea and vomiting.
How is a perforated bowel diagnosed?
Blood tests are carried out to check for signs of infection or blood loss. Usually chest x-rays would be performed, both lying down and sitting up, to see if there is any sign of air under the diaphragm – a sign of perforation. A CT scan may be performed.
Is this a medical emergency?
How is bowel perforation treated?
Usually emergency surgery will need to take place to repair the hole and stop the contents of your bowel emptying into your abdomen, leading to infection and sepsis. To prevent the spread of infection and sepsis, intravenous antibiotics and fluids are needed.
Sometimes, and with prompt diagnosis and repair, it is possible to perform what is called an ‘end-to-end’ repair. This is where the damaged portion of the bowel is removed and the ends are sewn together. This is much better for the patient because recovery is much faster.
However, if this type of repair is not possible then a ‘stoma’ has to be created. This is where a loop of bowel is brought to the surface of the abdomen leading an attaching to a stoma bag that sits outside of your body. This allows your bowels to rest as the contents of your intestines empty into the bag through the stoma. This is usually a temporary measure. Further surgery is required at a later date to reattach your intestines so that the stoma is no longer required. However occasionally, for various reasons, it is not possible to reverse a stoma and a patient has to live with a stoma bag for life.
When is it not possible to reverse a stoma?
There can be various reasons for a patient ending up in this unfortunate situation as follows:
- If there has been a build-up of scar tissue that would make more abdominal surgery too risky for the patient.
- It won’t be performed if it will not restore bowel function, for example, in the case of some bowel cancer patients.
- A reversal won’t restore bowel function if there isn’t enough rectum left intact to ensure good muscle control.
- Active disease of the bowel has to be excluded before stoma can be reversed.
- Other medical conditions may prevent reversal surgery, such as a flareup of a rheumatic condition, meaning a patient has to take steroids.
What are the complications of a perforated bowel?
If there are delays recognising the perforation and a failure to urgently repair it, the contents of the intestine will continue to empty into your abdomen leading to infection, sepsis and ultimately death. For women of childbearing age, perforated bowel can, in some cases, impact on their fertility.
Is a delay in diagnosis of a perforated bowel negligent?
It is therefore very important indeed that signs of a perforated bowel, whether caused by a medical condition or during abdominal surgery, is promptly recognised. In cases of surgical injury, in most cases, the perforation should be detected at the time of surgery and repaired immediately. If not, this is likely to mean that the surgeon did not exercise reasonable skill and care.
There should be a high index of suspicion for patients suffering from medical conditions that can lead to perforated bowel who present with abdominal signs and symptoms. A delay in diagnosis, and a failure, for example by a general practitioner in referring to hospital, is often negligent.
Once perforation is suspected, or diagnosed, failure to provide prompt protection from overwhelming infection with intravenous antibiotics and fluids would be negligent.
Sadly, we have represented the families of loved ones who have died because of a failure to recognise signs and symptoms of a perforated bowel.
Case examples of perforated bowel compensation claims:
SB V COUNTY DURHAM AND DARLINGTON NHS FOUNDATION TRUST (2020)
£2.6million compensation awarded to a 50-year-old lady who suffered a perforated uterus and bowel following an endometrial ablation procedure in April 2017.
This was caused by a plastic sheath left inside her abdominal cavity in error which went undetected. She was discharged home but became acutely unwell overnight. She underwent emergency surgery the following day as she had developed peritonitis.
An attempt was made to repair the perforations without a stoma but this failed. She underwent further surgery to fit a stoma. She required Total Parenteral Nutrition through a line and found it difficult to manage her stoma. The stoma was eventually reversed but she still struggled to eat or drink without experiencing severe abdominal pain. She underwent further surgery to try to improve the appearance of her abdomen as she was left distressed by its appearance. She still required TPN overnight and had significant care needs.
She was unable to continue working and suffered with post traumatic stress disorder and depression. She could no longer manage in her two-storey house and her life expectancy was reduced by about 25 years. The majority of the award was for her future significant care and accommodation needs, as well as loss of earnings and pension.
COTTON V SHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST ( 2018)
£89,000 compensation was awarded to a 50-year-old lady who suffered a perforated bowel during a procedure to remove her ovaries in November 2019.
She suffered significant abdominal pain and became critically ill requiring care in the high dependency unit. It was some two days later before the perforation was detected and she underwent emergency surgery but developed sepsis. She had an ileostomy fitted which was not reversed until a month later. She was left with frequent and urgent faecal incontinence and had an increased risk of bowel obstruction. She was left with a disadvantage on the open labour market due to her ongoing health issues.
AJ V COLCHESTER HOSPITAL UNIVERSITY NHS FOUNDATION TRUST ( 2018)
£85,000 compensation was awarded to a 39-year-old lady who suffered a delay in diagnosis of a condition called Ogilvie’s syndrome (which acts like an obstruction of the colon), following the birth of her child by Caesarean section in January 2012.
She suffered severe abdominal pain, vomiting and diarrhoea. Due to delays in treatment and management, it was not until some four days later that it was discovered her bowel had perforated and she was suffering with faecal peritonitis. She underwent an ileostomy and spent a prolonged period of time in hospital. Her stoma was later reversed but she was left with ongoing bowel disturbance which required her to modify her diet. She was also left with an increased risk of developing gallstones and B12 deficiency. She suffered a 13cm scar which would require scar revision and therapy.
If you have been affected by perforated bowel as a result of surgical trauma or delay in diagnosis, speak to our friendly team today. You have nothing to lose. We offer no win, no fee, so you do not have to worry about the cost of a claim.