Barking, Havering and Redbridge University Hospitals NHS Trust

3. Ms R complains that in April 2019 a surgeon at the Trust found an adhesion between her uterus and anterior abdominal wall during surgery and did not tell her or include this information in her discharge letter. She also complains they did not treat the adhesion or report this to the gynaecology team they referred her to after the operation.

4. Ms R says as a result she lost the opportunity to make informed decisions about her health to manage the issue, and the team treating her did not have the full information. She says if they had known, they may have done more investigations and exploratory surgery sooner and offered her medication. She explains this has caused her distress and sadness and after surgery she continued to experience pelvic pain which she was later told was caused by pelvic adhesions. She says the untreated adhesion most likely contributed to the development of her adenomyosis (where the womb lining grows into the muscle in her womb) and rupture of one of her fallopian tubes. In 2023 Ms R explained her pelvic organs were found to be severely fused together. She says she experiences severe abdominal pain, bleeding, recurrent infections, incontinence, dizziness, nausea, fainting, neurological pain, and a loss of functionality. She adds she is permanently disabled, and her quality of life is significantly lower. She says she has been told that it is too risky to surgically treat her severe multiple pelvic adhesions (ovaries, uterus, ureters, bowel, abdominal wall) as there is a high risk of rupturing her affected organs.

5. Ms R is seeking service improvements, so these failings do not happen again, and a financial remedy.

6. Ms R has a history of endometriosis, a condition where cells similar to those in the lining of the womb (uterus) grow in other parts of the body. Endometriosis can cause ‘adhesions’ to develop in the body, when inflammation causes scars which form bands connecting organs together. Extensive adhesions can cause pain and other complications.

7. In April 2019, a surgeon at the Trust carried out a diagnostic laparoscopy (keyhole surgery) to explore a swelling in Ms R’s left groin. They removed significant scar tissue and confirmed she had endometriosis. The surgeon also noted a right-sided ovarian cyst and an adhesion between her uterus and anterior (front) abdominal wall.

8. After the surgery, the surgeon referred Ms R to the Trust’s gynaecologists for further investigations and treatment.

Telling Ms R about the adhesion

12. Ms R complains that her surgeon did not tell her that they had found the adhesion after the surgery or include this information in her discharge letter. As a result, she says she was unable to make informed decisions about her health.

13. The Trust agrees that the surgeon did not tell Ms R. It says this is because the adhesion was minor and would not have changed the clinical plan. It also said there was no evidence of endometriosis, other than the scar tissue the surgeon removed. It other words, the Trust is saying that Ms R did not need to know.

14. General Medical Council guidance ‘Good medical practice’ (GMP) paragraph 32 explains how doctors should communicate effectively with patients. It says, ‘You must give patients the information they want or need to know in a way they can understand’.

15. Our adviser explained that if adhesions are a significant clinical finding – that is one which impacts clinical decision making – they are described as ‘extensive’ or ‘dense’. They clarified this was not the case in Ms R’s surgery. They said doctors should communicate significant findings to patients in line with GMP paragraph 32. It is not reasonable, they said, to expect doctors to communicate every finding, such as a minimal adhesion, to patients.

16. GMP paragraph 32 also says that doctors should give patients information they want to know. With hindsight, Ms R clearly wanted to know about the adhesion her surgeon found. Every patient is different, and some patients want to know more than other patients do. We do not think we can reasonably say the surgeon should have anticipated Ms R would want to know about an adhesion which they thought did not affect the clinical plan.

17. On this basis, we do not think it was unreasonable for the surgeon not to tell Ms R about her adhesion, either in her follow up appointment or the discharge letter. We have therefore not seen indications of failings. We do understand she would have preferred to have known.

Treating the adhesion

18. Ms R was unhappy the surgeon did not operate on the adhesion when they saw it. The Trust confirmed this did not happen because it was a minor finding.

19. Our adviser explained that there is no guidance or common consensus which says whether a surgeon should or should not divide adhesions in this circumstance. The surgery was to treat Ms R’s groin pain, and the surgeon did remove scar tissue in this area, which successfully treated this pain. They said it is unlikely that the adhesion was causing Ms R’s symptoms. They advised that dividing adhesions can cause bleeding and damage to organs, although ‘minimal’ adhesions are less likely to do so. Individual surgeons use their clinical experience and expertise to decide whether to divide incidental adhesions, such as Ms R’s surgeon found during her surgery.

Therefore, we have not seen indications of failings in the surgeon’s decision not to operate on the adhesion.

Informing the gynaecologist

20. Ms R complained the surgeon failed to tell her gynaecologist about the adhesion when they referred her. The referral was for management in relation to the finding of endometriosis in her groin and the ovarian cyst.

21. The Trust said this was not a significant finding, so the surgeon did not report it to the gynaecologist. It added the referral mentions the photos taken during the laparoscopy, which the gynaecologist confirmed they had seen.

22. GMP paragraph 44a says doctors ‘must share all relevant information with colleagues involved in your patients’ care within and outside the team, including when you… refer patients to other health or social care providers’.

23. Our adviser explained that the adhesion was not clinically relevant to the referral to gynaecology, for the same reasons the surgeon did not need to mention it to Ms R. The referral did include the endometriosis in Ms R’s groin and the ovarian cyst, which were the significant findings from the surgery.

24. It appears that the referral included relevant findings in line with GMP and therefore there are no indications the surgeon did anything wrong here.

25. We are sorry that Ms R is now severely affected by the adhesions in her pelvis and it is understandable she is concerned she could have avoided some of her experience.

26. We have seen no indications of failings and we decided not to take further action about Ms R’s complaint. We hope she finds our explanations helpful and reassuring.

1. We have carefully considered Ms R’s complaint about the Trust. We have seen no indication that anything went wrong when a surgeon at the Trust found she had adhesions.

2. We recognise that Ms R’s health is now significantly affected by endometriosis and adhesions throughout her pelvis. She has clearly explained just how painful and distressing this is for her. It is natural she wonders if some of this could have been avoided if she had known about the adhesions the surgeon found.