Perforated Bowel Compensation

Linda, 35 years old, York

Linda was born with a congenital cranio-facial abnormality known as Pierre Robins Syndrome (PRS).  She had had 3 previous pregnancies with no problems. When she became pregnant for a fourth time, she was booked for antenatal care at her local general hospital.  When it was suspected that the baby was affected by PRS she was transferred to a teaching hospital where the diagnosis was confirmed.

Linda gave birth at the teaching hospital, by elective caesarean section with ex-utero intrapartum treatment (EXIT).  This is a method of maintaining the utero-placental circulation during the caesarean section to permit an airway to be established in the baby prior to full delivery.

A Redivac drain was inserted into her abdomen in view of the risk of bleeding following the procedure. The day after the operation it was noted that Linda had a swollen but soft abdomen, but as there was no vomiting and she was feeling hungry it was agreed that the Redivac drain could be removed. 

Following removal of the drain Linda became increasingly distressed with abdominal pain and swelling. It is likely that a perforation to Linda’s caecum had occurred when the Redivac drain was removed due to the midwife failing to adequately discontinue suction from the drain prior to its removal. 

An abdominal X-ray was performed and a bowel obstruction suspected. Linda was reviewed by a Surgical doctor the diagnosis was post-operative ileus (slowing down of normal bowel activity) rather than anything more serious. 

The symptoms continued for a week although she was noted to be feeling better, and began to eat and mobilise. However, she had a persistently increased heart rate, an elevated white cell count, a reduced serum albumin, abdominal distension and oedema of the abdominal wall and legs with subsequent blistering. 

Almost two weeks after giving birth, Linda complained of sudden onset of acute abdominal pain and was found to have a clinical picture consistent with sepsis.

A CT scan suggested the presence of ascites and air in the peritoneal cavity, almost certainly due to a perforation of the bowel. Linda underwent emergency laparotomy and was found to have generalised peritonitis, with 2 litres of free pus and fluid. She developed acute respiratory multi-organ failure and died a week later.  

JMW Solicitors alleged had Linda been provided with an appropriate standard of care she would have undergone early laparotomy, and would not have developed generalised peritonitis.  Surgical intervention at any point up until her sudden deterioration would, in all probability, have saved her life.

Linda was survived by her 4 children, unfortunately, due to her extensive disabilities, the daughter born with PRS died before the conclusion of the claim. The hospital admitted causation, namely that but for that negligence the deceased would have survived and the claim was settled for £275,000.