C suffered from perianal abscess. On 1 May 2008 he underwent drainage and insertion of a seton (suture in the fistula which allows it to drain and heal).
On 28 July 2008 he underwent fistulotomy then developed incontinence and underwent colostomy.
“C contends that the surgery carried out by D was negligent in that he either divided the entire internal anal sphincter or the upper part of the sphincter was already divided or destroyed and the operative procedure carried out by Mr Robinson which was to cut the lower part of the sphincter was inappropriate in the circumstances… D had failed to ascertain that the upper part of the sphincter was divided or destroyed. By the end of the surgery the internal anal sphincter was divided.” (paragraph 13)
D asserted that the sphincter was destroyed by an ongoing septic process.
There was a temporal relationship between the onset of incontinence and the operation (paragraph 81).
The court found “too many uncertainties and evidential gaps” in the sepsis theory (paragraph 88).
After detailed consideration of clinical evidence the court made the following findings (paragraph 94):
i) did D divide the entirety of the claimant’s anal sphincter in July 2008? No
ii) if he did not, but divided the sphincter only below the dentate line:
a) had the upper part of the claimant’s internal anal sphincter been destroyed whether by infection or by the SHO at the first operation prior to 28 July 2008? Yes
b) if so, was D negligent in failing to appreciate that fact and proceeding to low fistulotomy? Yes
Judgment for the claimant.