Man, 29, left with lifelong bowel issues after complications following failure to remove appendix

Richard (not his real name), was admitted to the Royal Shrewsbury Hospital on 20 September 2018 with acute abdominal pain and strong familial history of appendicitis when he was aged 24.

It was considered that he was suffering from acute appendicitis and the following day, he was taken to the operating theatre for a laparoscopic appendectomy, a type of surgery to remove the appendix.

Examination of a specimen taken from the operation showed that the appendix had not been removed during the surgery. Instead, the surgeon had mistaken a piece of inflamed fatty tissue for the appendix.

Following the surgery Richard experienced several episodes of vomiting and was very unwell so was treated with antibiotics and fluids. His vomiting and diarrhoea was so severe that on 24 September a nasogastric tube was inserted. On 27 September, Richard’s symptoms appeared to be improving and he was discharged home.

However, less than two weeks later, he was readmitted to hospital with a fever and abdominal pain and underwent a further laparotomy surgery the next day.

A large part of Richard’s bowel was removed. Following this operation, Richard experienced a difficult recovery in hospital and developed pneumonia. Since the surgery, Richard has been diagnosed with severe bile salt malabsorption (a long-term gastrointestinal disease) for which there is no cure and he will remain on medication for life to manage his symptoms. He continues to suffer with ongoing and painful bowel symptoms, including faecal incontinence, faecal urgency, diarrhoea, and pain and has had to make alterations to his diet to reduce his ongoing symptoms. His mental health has also suffered as a result of his injuries.

It was Richard’s case that the surgeon undertaking the appendectomy on 21 September 2018 failed to identify his appendix, instead removed a piece of fatty tissue and damaged blood vessels supplying sections of the small bowel. This led to reduced blood flow to the small bowel and caused significant injury and a fistula. In turn this led to the unnecessary loss of a significant length of Richard’s small bowel.

The trust admitted breach of duty in failing to remove Richard’s appendix during the first operation, and accepted that the laparoscopic procedure on 21 September 2018 damaged blood vessels in the mesentery of the terminal ileum (small bowel).

The trust apologised to Richard for the “substandard care he received in respect of the laparoscopic appendectomy and the failure to remove the appendix as planned”.

The operating surgeon from Richard's first operation was a locum who has now left the trust. The trust confirmed that Richard’s case was discussed with the surgeon, and he has been able to reflect on the errors made. Support has also been made available at The Shrewsbury and Telford Hospital NHS Trust to ensure that this mistake does not happen again.

However, whilst the trust accepted failings, they did not accept that the need for subsequent surgery, or the cause of Richard’s injuries (including ongoing bowel symptoms and bile acid malabsorption) would have been avoided or were a result of those failings.

Richard was represented in his clinical negligence claim against The Shrewsbury and Telford Hospital NHS Trust by Leigh Day medical negligence solicitor, Kriya Hurley, who secured a settlement of £130,000.

Richard said:

“I will live with severe bile acid malabsorption for the rest of my life. I’m grateful to Kriya and Leigh Day for their support and efforts in achieving this settlement, and it is a huge relief for this process to have arrived at a positive conclusion. This settlement feels like it will go some way to helping me manage my condition going forward, and towards a recognition of the mistakes made in my care at the Royal Shrewsbury Hospital.”

Leigh Day solicitor Kriya Hurley said:

“I am delighted that we have been able to achieve this settlement for our client. I am pleased The Shrewsbury and Telford Hospital NHS Trust have confirmed that lessons have been learnt from this incident – patient safety is paramount. Richard is a young man who now has a lifelong bowel condition and ongoing difficulties which will impact on all areas of his life. I hope the settlement allows Richard to access the help that he needs in relation to his injuries now and in the future.”