Delay in diagnosis of retained surgical swab

A 47-year-old woman underwent cholecystectomy. Eight years later she was referred to a physician because of hepatic enlargement and abdominal tenderness. A course of antibiotics failed to resolve her symptoms and an initial diagnosis of hepatic carcinoma was made.

Chest X-rays showed elevation of the right hemi-diaphragm, pleural reaction at the right costophrenic angle and elevation and thickening of the horizontal fissure. An opacity below the right hemi-diaphragm was overlooked. Apart from the presence of intermittent abdominal discomfort the patient's continued well-being required revision of the diagnosis and she was considered to have a chronic hepatic abscess. During the ensuing 12 years until approximately 20 years after the cholecystectomy the patient received ongoing regular treatment from the specialist and her GP in the form of various injections.

Twenty years after surgery the then 68-year-old woman consulted a new doctor about her continuing abdominal pain and discomfort. Barium meal showed liver enlargement with two calcified masses which were confirmed on a CT scan. Laparotomy revealed two large abscesses in the subphrenic space above the liver; the abscesses were separated by the falciform ligament. The right subphrenic cavity contained, besides pus, a large surgical swab. The abscess wall had become calcified. Following this surgery the patient made an uncomplicated recovery. Her solicitors brought a claim against the hospital where the cholecystectomy had been performed and liability for the retained swab was admitted by the hospital's solicitors.

The solicitors joined the MDU member, the physician, and the patient's GP, a member of another defence organisation, to the proceedings alleging that they had contributed to the delay in diagnosis. Expert radiological opinion on the X-rays taken when her condition was first investigated confirmed that there was evidence of a retained surgical swab because of clearly visible swab marker wires below the right hemi-diaphragm.

After long and protracted legal negotiations following the court's assessment of damages against the hospital, a settlement with the solicitors for the hospital was reached. The MDU contributed £5,400 towards a total of £7,000 in settlement of the hospital's claim against the physician and GP. The patient received a total of approximately £27,000 in compensation for the overlooked swab.

Because of protracted and expensive legal negotiations and representation during the initial assessment of damages hearing the MDU's legal costs amounted to in excess of £22,500.

This page was correct at publication on 01/01/2002. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.