Devonport v Gateshead Health NHS Foundations Trust [2016] EWHC 1729 (QB) (13 July 2016)

… in 2008 the Claimant was diagnosed with carcinoma of the cervix stage 2A. She underwent a radical hysterectomy with destruction of lymph nodes performed at the Hospital on 10 November 2008 (the “hysterectomy”). She was released from Hospital within a few days of the hysterectomy, but re-presented at her GP with symptoms of infection on 28 November 2008. Investigations showed that she had developed an abscess in her psoas muscle. That abscess was drained under CT guidance on 18 December 2008. She was discharged home and followed up in the Defendant’s outpatient gynaecology oncology clinic. In early 2009, the Claimant started to complain of pain in her right lower abdomen. Investigations showed right hydronephrosis (dilation of the kidney), as well as a cystic lesion developing on her right ovary involving adjacent tissue (the “ovarian mass” of inflamed tissue). She was referred to the urologists who identified a stricture (or narrowing) of the ureter. On 4 June 2009 her right ureter was stented (by inserting a tube, or stent, to protect the ureter). On 7 September 2009 the stent was changed. On 23 September 2009 she underwent surgery under the gynaecologists to remove the ovarian mass, including the right fallopian tube and ovary (a “salpingo-oophorectomy”). Subsequent histology of the excised ovarian mass showed “vegetable matter” in the ovarian tissue which must have come from the bowel. The Claimant continued to complain of pain. The ureteric stent was again changed on 4 January 2010, but the ureteric stricture was now noted to be longer. On 25 March 2010 she underwent re- implantation of the right ureter. Tests showed that her right kidney function was deteriorating further and in October 2010 she presented with right loin pain. Further attempts at stenting were unsuccessful. She eventually underwent right nephrectomy (removal of the kidney). She remains in pain with reduced mobility. (paragraph 3)

The Claimant alleges negligence in two aspects of the care she was afforded throughout this period by the Defendant. The following is a summary.

i) she alleges negligence in the conduct of the hysterectomy. She says that her small bowel was perforated during this operation; that perforation led to leakage of bowel contents which caused the psoas abscess, which in turn caused the ovarian mass to form, which in turn put pressure on the ureter, which led to the kidney problems and all the other problems from which she now suffers.

ii) she alleges negligence in the preparation for and conduct of the salpingo-oophorectomy. She says that the gynaecologists should have involved the urologists much more closely in forming a joint plan, and if they had done so, a urologist would have been present in theatre for the salpingo-oophorectomy, and if that had happened, the urologist would have taken the opportunity to protect the ureter once it was exposed during surgery, and if that had happened, the ureter would have been preserved intact and no further surgery on it would have been required, and if that had happened, the right kidney would not have failed, and much of the Claimant’s current pain and functional deficit would have been avoided. (paragraph 4)

The Defendant denies negligence. The following is a summary of its arguments.

i) The hysterectomy was carried out with reasonable care and surgical skill and no bowel perforation occurred during the course of it. The Claimant developed an infection following surgery, which was not a consequence of any negligence, rather is a known complication of this surgery. The infection caused the psoas abscess, and in due course led to the ovarian mass, which itself fistulated into the adjacent small bowel. This is how the finding of vegetable matter in the histology is explained.

ii) The Defendant further argues that the gynaecologists treating the Claimant did coordinate their treatment plan with the treating urologists in a reasonable manner by exchange of letters between the two teams. In any event the outcome for the Claimant would not have been any different even if there had been better or different liaison between the gynaecologists and the urologists. (paragraph 5)

After detailed consideration of expert evidence from many disciplines the claim was dismissed.