The clinical negligence team at Penningtons Manches LLP has recently settled a claim against Nottingham University Hospitals NHS Trust for the retention of an appendix stump during laparoscopic appendicectomy surgery.

The claimant attended the Queen’s Medical Centre in Nottingham in February 2014 with a history of right lower abdominal pain and reduced appetite. He was admitted and referred to the surgical team who, after examination, diagnosed him with appendicitis and he was consented for a laparoscopic appendicectomy.

The surgery itself was noted to be uncomplicated and the claimant was discharged home the following day. However, in November he again attended the accident and emergency department at Queen’s Medical Centre with a right sided and lower abdominal pain. His history of an appendicectomy was noted and he was admitted with a working diagnosis of cholecystitis (infected gallbladder).

After his admission to hospital, routine bloods were taken which confirmed a raised white cell count and raised CRP. As there were concerns the claimant was septic, a CT scan of the abdomen was performed.

The CT findings confirmed that the symptoms were most likely to represent appendicitis and a remnant of the appendix stump was noted. The claimant was subsequently consented for an appendiceal stumpectomy. During surgery, a 2.7cm long appendix stump was removed.

Following these events, the claimant was understandably concerned that he had undergone further surgery to remove part of his appendix (that he assumed had been removed in February 2014) and he subsequently instructed Penningtons Manches to investigate a clinical negligence claim on his behalf. After reviewing the claimant’s medical records, the clinical negligence team instructed a general surgeon to prepare a report commenting on breach of duty and causation. This report was supportive and identified a number of concerns about the performance of the original appendicectomy in February 2014; specifically that the retention of a 2.7cm stump would not be supported by a responsible body of medical opinion. The very fact that the appendix stump was retained was evidence in itself that the surgery had been carried out in a substandard manner. The expert considered that had the appendix stump been appropriately removed, the patient would have avoided the subsequent need for further surgery and ongoing abdominal pain.

Penningtons Manches prepared and served a formal letter of claim to the trust and was able to secure a full admission of liability soon after. The trust acknowledged the failings in the claimant’s care and accepted that, had these failings not occurred, he would not have required further surgery.

Following the early admission by the defendant, Penningtons Manches took steps to quantify the claim and settlement was achieved soon afterwards.

Amy Milner, an associate in the clinical negligence team who handled the claim, said: “We have seen an increase in the number of enquiries that relate to the performance of appendix surgery, and specifically the failure to remove the entire appendix resulting in ongoing problems and more often than not, the need for further surgery. Given our experience with these types of cases, and the expert evidence we have obtained, we know that unless the retained appendix stump is very small (millimetres) or there is severe inflammation (ie the appendix has perforated), it is indefensible not to remove the entire appendix during surgery.

“It is clear that NHS Resolution (NHSR), which deals with clinical negligence claims on behalf of NHS trusts, is aware that these sorts of cases will be very difficult to defend, and it is therefore a credit to the trust and NHSR that liability was admitted very early on. An early settlement was reached without the need to incur substantial legal costs fighting the claim.