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In Friendship Kath Findlay
The UK Adhesions Society
<mailto:Kath.Findlay@adhesions.org.uk> Kath.Findlay@adhesions.org.uk
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UK Doctors Warned About Post-Op Adhesions Article 20 Adh July 10th 2001
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-- LONDON (Reuters Health) Jul 09 - Physicians in the UK have been warned that they need to be more aware that patients with abdominal pain who have recently undergone surgery may have a potentially dangerous tissue adhesion.The caution comes from a senior surgeon who has investigated the number of medico-legal claims against physicians involving adhesions over the last decade. Dr. Harold Ellis, from Guy's Hospital in London, found that surgical complications are a growing source of litigation.
"Surgeons, gynaecologists and general practitioners must be alert to the possibility that obstructive symptoms early and late after abdominal surgery are likely to be caused by adhesions," Dr. Ellis writes in the July issue of the Journal of the Royal Society of Medicine. "Delayed diagnosis can result in gangrene and even perforation of the strangulated bowel, with substantial morbidity and mortality."
Along with life-threatening blockages in the small bowel, adhesions can cause infertility and severe abdominal pain. Up to 70% of all cases of small bowel obstruction are thought to be due to adhesions. One of the biggest dangers is that surgery to remove the obstruction carries a high risk of further complications, such as perforations to surrounding tissue.
Dr. Ellis examined records from the UK's Medical Protection Society (MPS) and Medical Defence Union (MDU), medico-legal bodies that represent physicians in cases of litigation.
Between 1989 and 1999, MPS records showed that 13 patients had claimed damages as a result of adhesions. In nine of these cases, general practitioners were accused of delaying or failing to make a diagnosis, three were against gynaecologists for missed diagnosis and bowel damage during surgery, and one was against a surgeon — again for bowel damage.
MDU data showed there had been 77 claims by patients. Most referred to delayed or missed diagnoses, but many cases involved internal injuries, pain and infertility. Fourteen of the MDU cases had been settled out of court at an average £50,765 per case.
"General practitioners, surgeons and gynaecologists need to be aware of the increasing burden of medico-legal claims arising from these complications," Dr. Ellis writes. But he stressed it can be difficult for GPs to accurately diagnose a blockage because they see so few cases.
"A general practitioner may see one case every 5 or 10 years, or never see one at all," he told Reuters Health.
Dr. Ellis added the high risk of adhesions meant patients should routinely be informed of the risks before giving consent to surgery. Current advice to surgeons is that patients should be notified if there is more than a 1% risk of them being damaged.
"In the US, some surgeons video the interview with the patient [just] in case, 2 years later, the patient says nobody told them [about the risks]," he said. "There are some operations that we know are very likely to produce small bowel obstruction. For example, a total removal of the colon carries a 25% risk."
He said surgeons might be able to limit the risks of adhesions to the small intestine. One way might be to avoid starch-powdered gloves, because the powder can come off and create blockages. These gloves were commonly used up until the early 1980s, but have since become less popular.