Consultant Fails to Spot that Post-operative Infection is Necrotising Fasciitis
Natalie had suffered with severe and worsening ulcerative colitis for a couple of years by the time it was decided that she would need to undergo surgery. Ulcerative colitis is an inflammatory bowel disease and was causing Natalie increasing problems with her bowel.
Natalie's surgery involved the removal of part of her bowel and the creation of a stoma.
Natalie had been taking immune-suppressing medication for her ulcerative colitis and also suffered with gestational diabetes. Both these factors meant that she was at a greater risk of surgical infection than would normally be the case.
Following her surgery, Natalie appeared to be recovering well for couple of days. After the third day, however, she took a turn for the worse with low blood pressure and a fast heart rate. She also seemed to have a low urine output. She was reviewed the following day by the specialist registrar and the consultant who had performed her surgery. It was considered that she might have sepsis or a pulmonary embolus and a CT scan was requested.
The CT scan ruled out the likelihood of a pulmonary embolus and showed that the rectal stump, which remained after the bowel had been diverted, was filled with fluid.
At this point, Natalie should have undergone immediate surgery to drain the fluid and resolve the infection at the rectal stump.
Instead, Natalie was started on antibiotics and transferred first to the High Dependency Unit and then to Intensive Care. Over the next few days, she remained in ICU where she continued to exhibit signs of sepsis and it was also noted that she had developed an irregular fast heartbeat.
A small blister on her left thigh was also observed and it was considered that she might be developing deep vein thrombosis or cellulitis. There was still no decision to carry out surgery to drain the fluid which had been seen on the CT scan.
Natalie's condition continued to deteriorate and her temperature continued to increase. She also developed redness and swelling to the abdomen which was considered to be further cellulitis.
It was now fifteen days since her operation and nine days since she had been transferred to intensive care.
It was finally decided that the fluid needed to be drained. Unfortunately, Natalie continued to deteriorate whilst waiting for this procedure and when surgical exploration of her abdomen was finally carried out, a large extent of necrotic tissue was discovered and removed and Natalie was given a diagnosis of necrotising fasciitis.
There were two further surgical procedures over the next few days to remove further tissue and wash out the wound and insert drains. Natalie appeared to improve for a few days before taking a turn for the worse. A further surgical procedure was necessary to remove further infected and necrotic tissue.
Over the following weeks and months Natalie's condition fluctuated considerably and she had to undergo numerous further operations to assess and treat her abdominal condition.
Eventually, she was considered well enough to engage with the Plastic Surgery team to try to provide skin grafts to help close her wounds and improve the scarring she had suffered through her numerous debridement procedures.
When Natalie approached Glynns to help her investigate the quality of her care, our medical expert was critical of the failure to undertake an exploratory laparotomy when it first appeared that she had severe sepsis and the CT scan showed fluid around the rectal stump. His opinion was that, had this been carried out, Natalie would probably not have developed necrotising fasciitis, suffering considerable pain and distress and requiring weeks of surgical procedures, each carrying its own risk of further problems.
He was further critical of the delay in diagnosing a necrotising infection when there were many signs that Natalie's condition was more sinister than cellulitis. Natalie had clearly been extremely unwell.
A necrotising fasciitis infection can spread rapidly and, therefore, the earlier a diagnosis is made, the sooner debridement surgery can be carried out and infected tissue can be removed. The later a diagnosis is made, the more surgery the patient may require and the more extensive damage they are likely to suffer.
Furthermore, the delay in draining the fluid which had been observed was criticised.
Natalie continued to suffer periods of illness but attempted to return to work although she found that she could only manage part-time and was restricted in many activities. She is unable to lift due to the damage to her abdomen and has been unable to return to activities she previously enjoyed due to loss of core strength. She requires assistance around the home and her family has been impacted by the appalling and life-threatening period of illness she suffered.
Following our investigation into the quality of her care and due to the shocking impact she suffered as a result of the negligence of her medical professionals, Natalie received over £ 500,000 in compensation.
(Details which might identify our client have been changed.)
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