Malignant ascites
13.Mrs A says Mr C had malignant ascites when he was in hospital during January and February 2023, but his condition was misdiagnosed by the Trust. Malignant ascites is a build-up of fluid in the abdomen due to cancer.
14.We have considered Mr C’s records with support from our adviser, but we cannot find evidence of Mr C having a diagnosis of malignant ascites. Our adviser says that Mr C’s principal diagnosis was of gallbladder cancer with an associated small perforation. Unfortunately, Mr C’s cancer had spread locally causing it to be inoperable.
15.From the description of the examination findings and the plain abdominal x-ray findings in February 2023, our adviser says the abdominal distension (expansion of the abdomen due to gas or air) seen was likely related to reduced colon movement (ileus), with only a small amount of residual stool seen at the splenic flexure on the February abdominal x-ray. At other times, increased constipation was felt to be an issue, a common and longstanding problem for Mr C.
Faecal impaction
16.Mrs A says that Mr C had faecal impaction when he was in hospital during January and February 2023, but his condition was not treated promptly or correctly by the Trust. Faecal impaction is when solid, immobile faeces become stuck in the rectum.
17.We have considered Mr C’s records with support from our adviser, but we cannot find conclusive evidence of Mr C having faecal impaction. Our adviser says that Mr C’s rectum was found to be empty when it was examined.
18.Our adviser says that laxatives were appropriately used to treat Mr C’s noted constipation, in accordance with the NHS guidance for treating this condition. The dose of Laxido for a patient like Mr C will be titrated according to response. There was no indication for giving Mr C an 8-sachet dose that can occasionally be used for patients who have faecal impaction. 1 to 2 sachets of Laxido once to twice daily with senna was an appropriate regime for Mr C.
Bowel movement
19.Mrs A says that Mr C’s lack of bowel movement when he was in hospital was initially ignored, and then not treated properly or monitored by the Trust.
20.We have considered Mr C’s records with support from our adviser, but we have not found any evidence that a lack of bowel movements was ignored by staff at the Trust.
21.Our adviser says there is evidence from Mr C’s initial admission to hospital on 18 January 2023 that a change in his bowel habits with watery stools was appropriately investigated and infection was excluded. A trial without oral iron was also tried to see whether this would be beneficial.
22.It is also noted that Mr C had a CT thorax, abdomen, and pelvis scan. Our adviser says this revealed the bile duct stent and small gallbladder perforation, but no comment is made to suggest faecal overload/impaction was identified. As above, appropriate laxatives were given to Mr C to treat his constipation and related lack of bowel movement.
Conclusion
23.Mr C was in and out of hospital for a few weeks in January and February 2023 due to several conditions including constipation and diarrhoea rather than malignant ascites or faecal impaction. We are sorry to hear how much he suffered, and the pain and discomfort he was in. This must have been distressing for his family to witness. Our investigation has found that he was treated appropriately with laxatives and further investigations were carried out when his bowel habits changed. Unfortunately, Mr C had underlying gallbladder cancer which had spread and become inoperable. It was cancer that caused Mr C’s sad death on 17 February 2023.
24.This concludes our investigation of the complaint. Please note there are legal restrictions on disclosing information that we give you. This means that you cannot share or make public any information or documents we gave you during our investigation. The legal restrictions do not apply to this final report.