A surgeon did not tell a patient about what happened during an operation

What happened

When the surgeon nicked Mr T's spleen, he was able to stop the bleeding and the operation proceeded successfully. However, the surgeon considered the injury to be minor and did not tell Mr T what had happened because he did not think that it would lead to any complications.

Trust staff advised Mr T to rest for two weeks after the operation, and said that he could then go back to his normal activities. Four days after Mr T returned to his normal level of activity, he was admitted to the hospital as an emergency with severe abdominal pain. Investigations showed that his spleen had ruptured and was bleeding into his abdomen. Mr T had an emergency operation, during which his spleen was removed.

When Mr T complained to the hospital, he said that he was not complaining about the fact that the injury to his spleen happened during the initial operation, but that he was not told about it. He said that, had he known about the injury, he would have taken more care during his postoperative recovery period, and that his spleen may then not have ruptured.

What we found

We partly upheld this complaint. Injuries to the spleen are a known risk that can happen in up to 8% of operations on the colon, so the fact that the injury occurred was not a failing in itself. The General Medical Council's relevant guidelines, Good Medical Practice and Good Surgical Practice, both state that doctors and surgeons must tell patients about any complications or harm that happen during treatment, and act to put them right. This includes advising patients appropriately about their postoperative care.

The surgeon took action to put things right during the operation by stopping the spleen bleeding. However, he should have told Mr T about what had happened to his spleen during the operation. Trust staff should have given Mr T appropriate advice about his postoperative care, which in spleen injuries is to rest and refrain from normal activities for six weeks, and to avoid taking part in contact sports for four to six months. There were failings in communication between the surgeon and Mr T, in that Mr T was not told about the injury to his spleen or given appropriate aftercare advice.

Mr T felt that if he had been told about the injury and given appropriate aftercare advice, which he said he would have followed, his spleen would not have ruptured and he would not have needed the second operation to have it removed. Mr T was not given the chance to reduce the risk of his spleen rupturing because he was not told about the injury or given appropriate aftercare advice. Refraining from normal physical activities for six weeks after the operation would have reduced the risk of further bleeding in the spleen. However, we were not able to say that the spleen would definitely not have ruptured if the failing in communication had not occurred. For this reason, we partly upheld the complaint.

Putting it right

The Trust had already taken action to prevent the situation from happening again after responding to Mr T's complaint. It said it now asked all surgeons to discuss any complications that arise during surgery with the patient at the time that they occur, and to report any such complications on a critical incident form. We felt this was sufficient to prevent what happened from happening again to other patients at the Trust. However, the Trust had not told Mr T about this or apologised for the failing in communication.

At our recommendation, the Trust wrote to Mr T to acknowledge and apologise for the failing in communication, and told him about the action it had taken to prevent the failing from happening again.