Angela suffered from post-menopausal bleeding and a utero-vaginal prolapse and she underwent a vaginal hysterectomy and posterior colpoperineorrhaphy at the Royal Oldham Hospital.
The operation went well. She was discharged after five days. Approximately four days after her discharge from the hospital, Angela developed a high temperature and pain in her back.
Angela consulted her general practitioner, who diagnosed a urinary tract infection and prescribed antibiotics.
A few weeks later Angela attended an outpatient clinic appointment complaining of a slight vaginal discharge. Angela slight discharge was present and a high vaginal swab was taken but Angela was discharged back to the care of her GP.
Over the next few weeks, the discharge became worse so much so that she wore sanitary towels and Angela's GP prescribed her antibiotics.
The following month Angela experienced progressive abdominal distention and increasing vaginal discharge and developed problems with her bowels.
A few months after that Angela found that she could not sit down without pain and she was aware of the feeling of a lump inside her. Her abdomen was tender and she suffered cramping pains across the front of her lower abdomen. She was incontinent of both urine and faeces.
She was referred to the hospital. On rectal examination, a hard mass between the vagina and the rectum was identified and an urgent EUA was arranged . At this examination, a large recto-vaginal fistula was diagnosed.
A laparotomy and colostomy were performed. Angela was informed that she would have to use the colostomy for 6 to 8 months to allow the fistula to heal.
A number of weeks after the surgery an object discharged from Angela's vagina. Angela noted that the object was hard packed/compressed object like gauze, stained with yellow/greenish pus. It was stained with faeces and smelled similarly to the vaginal discharge.
The object was discharged approximately 30 minutes before the visit of the district nurse. Angela showed the item to the district nurse who told her to flush it down the toilet.
The fistula has remained infected and has not healed. Major abdominal surgery has been recommended, but the complications and risk of morbidity are significant and Angela decided that she did not wish to undergo the surgery. She will therefore be left with her colostomy.
We were instructed by Angela's legal expenses insurers, FirstAssist, to pursue a gynaecology claim for negligence.
Our expert gynaecologist considered that the most likely cause of the fistula was a retained swab.
Following extensive negotiations, on Angela's instructions, we settled the claim in the sum of £37,515.89 after exchange of expert evidence.
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