Elderly patient suffered ‘torrential bleed’ during routine operation

Pilgrim Hospital, Boston.
Pilgrim Hospital, Boston.

An elderly patient suffered ‘torrential’ bleeding during a routine operation at Pilgrim Hospital – prompting questions over her treatment.

Eileen Coupland lost the equivalent of her entire blood volume during and after a ‘difficult’ bowel operation when her spleen was damaged and removed, an inquest was told last week. She died days later.

Though it has been revealed it did not contribute to her death, South Lincolnshire Coroner Professor Robert Forrest said it was ‘sub-optimal’ that work had not been carried out to address the situation earlier.

Mrs Coupland, 82, had a catalogue of health issues when she went for surgery, but doctors said it was the only realistic option to treat the obstruction in her intestine. The coroner heard evidence from a blood specialist stating she was fit for the procedure, despite having previous problems with blood clotting. Complications during surgery led the spleen being damaged and removed.

Colarectal surgeon Pardeep Agarwal said: “There is a five per cent chance the spleen will be injured in this type of operation, and even a very small cut in the spleen can cause profuse bleeding. I was amazed at the way it bled. It bled torrentially. Normally it can be stopped, but it didn’t. To be on the safe side, we removed the spleen. At the end of the operation, I was quite satisfied that it looked fine.”

Head of critical care Andrew Norton confirmed a blood clot screening had not been carried out despite the concerns. He said: “It is my professional view that it would have been advantageous to have clotting screening earlier in the procedure. But, I am sure we were not able to save her. This was a fairly elderly lady undergoing complex surgery, which proved more difficult than expected.”

Mrs Coupland, of Winsover Road, Spalding, was taken back to surgery within hours, after a screening revealed she had severe problems. Pads were inserted to stop the bleeding and she was given blood clotting agents. But days later, on January 17, it was revealed she had suffered a major stroke and her organs were failing. She died later that day.

A post-mortem showed the injury to her spleen had led to her death.

At the inquest, at Boston Enterprise Centre on Friday, Prof Robert Forrest recorded a verdict of death by misadventure. He said: “There was a delay in initiating treatment with appropriate blood clotting factors, but once the laceration took place chances of survival were very low, so while sub-optimal, the failure of initial treatment would not have caused her death.”