Was major surgery the only option?

What happened

Mrs A, who had a history of inflammatory bowel disease, was admitted to hospital as an emergency. After a series of tests, staff decided that her large bowel was about to perforate. Clinicians considered that surgery was the only option, so she underwent major bowel surgery.

Unfortunately, Mrs A went on to develop worsening pain and a wound infection and needed two more surgical procedures. The Trust also treated her for pneumonia, septicaemia and pressure sores before she was discharged from hospital.

In response to Mrs A's complaint, the Trust was unable to confirm Mrs A's view that staff did not explain the purpose of the surgery and what it would entail. Overall, the Trust maintained that Mrs A had been given an appropriate standard of care and treatment throughout her hospital admission.

What we found

We looked at the information provided by Mrs A's representative and the Trust. We also looked at the Royal College of Surgeons' guidance Good Surgical Practice 2008 and the British Society of Gastroenterology guidelines for the management of inflammatory bowel disease.

The Trust did not follow the surgical guidance and there were failings in relation to communication and record keeping. However, Mrs A was extremely unwell so we were satisfied that the surgery was justified since her health would have continued to deteriorate, and her illness would have become immediately life-threatening without the surgery.

The decision to offer Mrs A surgery to remove her large bowel, rather than risk making her infections worse, was appropriate. Surgery was the only feasible treatment by the time it was performed.

We were satisfied that the discussions with Mrs A regarding the wound's recovery were reasonable.

Putting it right

The Trust apologised for the failings we identified and agreed to draw up an action plan to address the failings.