Out of court settlement for a substandard appendectomy

We have recently settled a claim against Epsom and St Helier University Hospitals NHS Trust for a client who endured avoidable pain and suffering, and an unnecessary second operation under general anaesthetic, following a substandard appendectomy (removal of the appendix).

In September 2020, our client presented to the emergency department at St Helier Hospital with severe abdominal pain and vomiting. Appendicitis was suspected at the outset in view of his symptoms and, following referral to the surgical team, a CT scan was performed, which confirmed acute appendicitis.

Our client subsequently underwent surgery. It is generally standard to send any tissue removed at surgery for testing, and the pathology results confirmed that the length of the appendix removed was less than half the average length of the human appendix. However, the findings were not appropriately appreciated by the treating clinicians at the time. Our client was subsequently discharged from hospital.

In December 2020, our client presented to the emergency department at St George’s Hospital with acute abdominal pain. He was reviewed by the surgical team and referred for a CT scan, which demonstrated that there was a significant remaining length of the appendix – that is, an ‘appendix stump’ – still present with inflammation. Essentially, our client had developed stump appendicitis due to the incomplete removal of the appendix in September 2020. Further surgery under general anaesthetic was required as a result.  

Investigations were carried out and expert evidence was obtained. The issues in our client’s care were highlighted to the trust within a letter of claim. It was alleged that the surgery in September 2020 was not carried out to an appropriate standard, in that there was a substantially incomplete removal of the appendix. Had the appendix base been appropriately identified and managed, this would have allowed for a complete removal. In such circumstances, our client would not have suffered with complications arising from stump appendicitis in December 2020, and would have avoided the need for further surgery. 

Following investigations by NHS Resolution (NHSR), Epsom and St Helier University Hospitals NHS Trust accepted that there was an appendix stump left in-situ, and a subsequent failure to check the size of the specimen and consider the possibility of a retained stump at the time of the surgery in September 2020. The trust admitted that if the anatomy of the appendix was unclear, or if the stump of the appendix had not been correctly identified, the surgery should have been converted to open surgery, which would likely have resulted in a complete removal of the appendix. 

The trust accepted that had our client received such treatment, he would have avoided the development of stump appendicitis and the subsequent need for further surgery. The trust apologised for the poor care afforded to our client and an out of court settlement was reached. 

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