Oxford University Hospitals NHS Foundation Trust

3. Mrs N complains about aspects of the care and treatment she received from Oxford Health NHS Foundation Trust (the Trust). Mrs N complains the Trust did not arrange a second abdominal CT scan which she had been told would be arranged following a failed colonoscopy in October 2021. She also complains that the Trust did not take account of her past medical history and did not scan the correct part of her abdomen when she was admitted to hospital for a second time in January 2023.

4. Mrs N says the Trust missed opportunities in October 2021 and January 2023, to diagnose and treat diverticular disease, meaning she needed emergency bowel surgery in February 2023, after she was diagnosed, which resulted in her needing a stoma.

5. Mrs N said the surgery has been devastating for her. She has had a diagnosis of post-traumatic stress disorder following her surgery. She now has a stoma, which she finds difficult to manage and the impact of her bowel surgery has been life changing.

6. Mrs N seeks an apology from the Trust and a financial remedy.

7. On 1 October 2021 Mrs N was admitted to the Trust with a four-week history of abdominal pain, vomiting and diarrhoea. She had an abdominal CT (computerised tomography) scan which indicated diverticulitis, and a coloscopy was arranged for her as an outpatient to rule out any other disease.

8. A colonoscopy took place on 18 November 2021, but the Trust was unable to image all of the colon. A follow up interval scan was recommended in a letter to Mrs N’s referring consultant. This was not arranged because the consultant was on long term sick leave.

9. On 11 January 2023 Mrs N was readmitted to the Trust with abdominal pain associated with nausea and diarrhoea. Mrs N had an ultrasound scan of her abdomen which showed ‘sludge’ in the gallbladder and blood tests showed mildly elevated inflammatory markers. An MCRP scan was arranged as cholecystitis (inflammation of the gallbladder) could not be ruled out. An MCRP is a specialised MRI scan to image the bile ducts, pancreas, liver, and gallbladder, diagnosing issues like gallstones or blockages.

10. As Mrs N could manage her pain at this time, she was discharged home and put on the ambulatory pathway to return for the MCRP on 16 January 2023.

11. The MCRP on 16 January 2023 confirmed sludge in the gallbladder but ruled out any gallstones. The scan also did not show features of bowel obstruction.

12. Mrs N was readmitted to the Trust on 20 February 2023 with abdominal pain and a swollen abdomen. She was found to have palpable bowel loops (loops of the intestine that can be felt during a physical abdominal exam). A CT scan was carried out which showed a large bowel obstruction. The CT also showed strictures, which would have been caused by a narrowing from a previous episode of diverticulitis, and would have caused scarring.

13. She had emergency surgery on 22 February 2023 (Hartmann’s procedure) which left her with a stoma. The pathological diagnosis was acute diverticulitis with abscess formation.

14. Mrs N was discharged home on 4 March 2023.

18. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen.

Second abdominal CT scan

19. Mrs N says that following her admission to the Trust in October 2021, a recommended colonoscopy failed, and the endoscopy team asked her consultant to arrange an interval scan (a type of CT scan). She says the Trust failed to arrange this scan.

20. The Trust said when she was admitted to hospital in October 2021, she had a CT scan of her abdomen which showed findings that could be diverticulitis, but further imaging was required to exclude other causes. Mrs N was referred for a routine colonoscopy which took place on 18 November 2021. This procedure failed due to a very tight bend in the sigmoid colon. It was considered that further colonoscopy attempts might be difficult, and the endoscopist requested an interval scan and had not arranged any further endoscopic examinations. This request was not actioned as the named consultant was on long-term sick leave, and the scan was not arranged.

21. The Trust have apologised for this. The Trust have said it would have been helpful for Mrs N to undergo further investigation following the failed colonoscopy as this would have meant there was no uncertainty about whether it was an intermittently flaring stricture (abnormal narrowing) or a chronic stricture with an inevitable need for surgery, which could then have been planned as an elective surgery.

22. We have seen from the records Mrs N had a failed colonoscopy on 30 December 2022. Our adviser explained where there is narrowing and a colonoscopy fails, the best option would have been to image the narrowing of the bowel to find out the cause of this. A CT colonogram (a CT scan which creates 2D and 3D images of the large bowel) could have been considered.

23. NICE guideline Diverticular disease: diagnosis and management, sets out, a contrast CT is recognised as the gold standard diagnostic test for acute diverticulitis and its complications. We would not expect a Trust to always provide a gold standard of care.

24. We can see in the records on 11 January 2023 the Trust’s working diagnosis was Mrs N ‘most likely’ was experiencing biliary colic. This is severe abdominal pain caused by gallstones blocking the gallbladder or bile ducts.

25. NICE guideline, Gallstone disease: diagnosis and management, says to consider magnetic resonance cholangiopancreatography (MRCP) if an ultrasound has not detected common bile duct stones, but the bile duct is dilated and/or liver function test results are abnormal. An MRCP was carried out on 16 January 2023. This was appropriate action to take in line with the guidance.

26. We recognise the Trust did not arrange a follow up CT scan, for which they have apologised. This would have been gold standard care. However, other imaging was completed to investigate her symptoms. We understand Mrs N feels had a CT scan been carried out she may not have required the surgery she had.

27. Mrs N’s working diagnosis on 11 January 2023 was that she was suffering from gallstones. While a second CT scan was not arranged given the working diagnosis, an MCRP was an appropriate imaging scan to complete in line with NICE guideline, Gallstone disease: diagnosis and management. We do not consider the Trust’s care fell below what we would expect to be an indication of a failing.

History and scan

28. When Mrs N was admitted to the Trust in January 2023, she told us the Trust did not take account of her admission and previous scan in October and November 2021. She also says the Trust did not scan the correct part of her abdomen when she was admitted to hospital for the second time. She tells us that staff did not listen to her explanations about where the pain was in her abdomen.

29. The Trust set out what is in Mrs N records. She was admitted to a surgical emergency unit and the team needed to assess her at that stage. Her medical records show she had a diagnosis of diverticulitis in October 2021. The junior doctors discussed her case and presentation with a consultant surgeon and there was no evidence of a bowel obstruction on this admission.

30. We cannot see any indication that Mrs N’s history was not taken.

31. Mrs N had an MCRP scan on 16 January 2023 (which included the whole abdomen) and she was admitted a month later on 20 February 2023 with a distended abdomen and a CT scan showed a bowel obstruction. She required open surgery and placement of a stoma as the bowel was so distended.

32. The Trust said Mrs N rapidly developed a large bowel obstruction between the MCRP and the CT scan, and it does not seem that there was a window of intervention which would have allowed for her to have surgery on a non-distended bowel (which was the reason for the stoma). In addition to this it could not be said for certain that if she had undergone an elective diverticular resection (as opposed to an emergency) that she would still not have needed a stoma.

33. We have seen from the records the Trust did consider her report of lower and upper abdominal pain and nausea. Based on her symptoms there was a working diagnosis of gallbladder disease. Our adviser said this was a reasonable diagnosis from the presenting symptoms and it was right to complete a MCRP scan. We have seen a consultant radiologist reviewed the MCRP scan. Our adviser told us had there been any evidence of a bowel blockage on this scan, the radiologist would have mentioned it in their report.

34. Our adviser says the Trust did scan the correct part of her abdomen. The scan performed was the correct scan to investigate gallbladder disease in line with NICE guideline, Gallstone disease: diagnosis and management and this was the working diagnosis at the time.

35. We have not identified any indications of failings in relation to the scan of her abdomen.

36. We understand this has been an extremely distressing situation for Mrs N, and we recognise how difficult it has been for her to undergo emergency surgery and the resulting stoma. We do not intend to minimise her experience. We thank Mrs N for bringing this complaint to our attention.

1. We have carefully considered Mrs N’s complaint about Oxford University Hospitals NHS Foundation Trust. Based on the information we have considered, we have decided not to consider Mrs N’s concerns further. This is because we have not seen any evidence that anything went seriously wrong. We are sorry if this decision is disappointing for her and causes further distress as this is not our intention.

2. We want to thank Mrs N for bringing this complaint to us. We understand that the bowel surgery has been devastating for her, and she continues to find this difficult to live with. We hope our explanation provides some reassurance about the care she received.