Delayed diagnosis of hernia strangulation

The scene

A patient with a known right inguinal hernia was seen at an out-of-hours GP unit by an MDU member. The patient complained of abdominal pain, but at the consultation told the GP there had been no vomiting, diarrhoea or change in bowel habit. The hernia was unchanged and the GP made a note that the patient was awaiting surgery for this, before recommending painkillers and that the hospital referral for surgery be chased up.

Three days later the patient was admitted to the surgical admissions unit, following a home visit where he complained of continuing pain in his abdomen and hernia. At the hospital it was noted that he'd had several episodes of the hernia remaining in the groin for two to three days, which had spontaneously resolved.

The patient complained of abdominal pain, but at the consultation told the GP there had been no vomiting, diarrhoea or change in bowel habit.

The patient was listed for surgery later that day, but this was delayed by a more pressing surgical emergency. The patient underwent a right inguinal hernia repair with bowel resection the next morning, which found a 2cm length of ischaemic small bowel with a very tight deep inguinal ring. Unfortunately the patient developed complications and required a further laparotomy and a small bowel resection.

The claim

The patient brought a claim against the MDU GP member, alleging she had failed to refer him to hospital which resulted in a delayed diagnosis of hernia strangulation. After the member came to us for assistance, we immediately sought independent expert advice.

Unfortunately these experts' opinions were not supportive of the member's actions, with a GP expert stating that the member was in breach of duty for failing to urgently refer the patient for a surgical assessment. A surgical expert was of the opinion that had the patient been admitted at the time of his consultation with the MDU member, the ischaemic changes in the small bowel would not have been present and he would have avoided the small bowel resection.

On the basis of the expert evidence obtained, and with the member's permission, we settled the claim in the early stages of the litigation. By doing so, we were able to resolve the matter quickly and minimise the costs incurred.

This guidance was correct at publication 16/07/2018. It 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.

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