20. 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. We have done this and have not found any indications something has gone wrong.
21. To help us reach a decision about whether the Trust provided Mr C with appropriate care when he suffered complications after his surgery, we looked at the National Library of Medicine journal. It says lack of blood supply is more common after emergency repair (as in Mr C’s case) and has a mortality rate of 50%.
22. We also looked at Good Medical Practice. We have summarised the relevant sections we have considered to convey the aspects that were key to our consideration of this complaint.
23. Good Medical Practice says doctors must provide a good standard of practice and care. If they assess, diagnose or treat a patient, they must adequately assess the patient’s condition, taking account of their history, their views and values, and where necessary, examine the patient. They must promptly provide or arrange suitable investigation or treatment and refer a patient to another practitioner when needed.
24. We also considered the Journal of Vascular Surgery. It refers to the use of a nasogastric tube to decompress the stomach.
25. Mr C’s initial progress following his surgery was as one might expect to see in those circumstances. There was initial improvement with the ability to wean from ventilation and blood pressure supporting medication. He started to deteriorate on day eight, after his operation.
26. The vascular team were reviewing Mr C. Ms A said she was concerned the gastric team did not review her brother. Our adviser explained vascular surgeons are aware of the complications of aneurysm repair and can identify and action these.
27. The vascular team involved the general surgical team at the second, third and fourth laparotomies (a procedure to open the abdomen and expose the organs) in line with Good Medical Practice.
28. The Trust noted Mr C had abdominal swelling on the first day after his operation. Our adviser told us this is normal after such extensive surgery. This is due to the body’s response to the trauma of surgery and the movement of fluid and some accumulation of gas in the colon.
29. We asked our adviser whether the Trust should have considered and checked for faecal overflow and impaction (leakage or blockage of stool liquid). They helped us understand that ileus (lack of bowel activity) is very common following surgery. A patient’s bowels usually return to normal gradually as they recover.
30. The Trust gave Mr C laxatives to help with his bowel activity and treated him with a nasogastric tube to decompress the stomach. The Trust also gave Mr C antibiotics and asked for clinical input from the clinical microbiology team. This was in line with Good Medical Practice and the Journal of Vascular Surgery.
31. Ms A told us she was concerned the Trust did not carry out an earlier X-ray, ultrasound or CT scan. The Trust’s own review of Mr C’s care considered a CT scan when he deteriorated on day eight, after his operation.
32. We know the Trust carried out a CT scan on 18 October. It did not show any evidence of bowel obstruction or poor blood supply, therefore there was no concern suggesting another CT scan was needed.
33. Our adviser told us that an abdominal X-ray or ultrasound scan would not have helped with the differential diagnosis of ileus (lack of bowel activity) and ischaemia (lack of blood supply to the bowel).
34. We cannot say, even on the balance of probabilities, that an earlier scan would have altered the outcome. This is because Mr C’s cause of death was the result of poor blood supply to his abdominal organs (colon, small bowel, stomach and liver) because of his rupture and repair of his aneurysm.
35. Our adviser helped us understand that Mr C’s bowel perforated (‘split’) due to a lack of blood supply to his colon.
36. National Library of Medicine journal tells us this is a known but quite rare complication of such surgery. It was the underlying condition of the rupture of his aortic aneurysm which led to the bowel perforation and poor blood supply, which led to his death.
37. We have not seen any indications that the Trust did not provide appropriate care. It is our view, it acted in line with the relevant guidance.
38. It must have been very upsetting for Ms A when her brother deteriorated following his surgery. We are mindful of how important her complaint is to her and the difficult experience she has had. We hope our decision on what happened can bring some closure to this sad event.