Concern over 82-year-old’s surgery care

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Questions have been raised over the way surgeons dealt with an elderly woman who suffered profuse bleeding during an operation.

Eileen Coupland lost the equivalent of her entire blood volume when her spleen was damaged during a “difficult” bowel operation at Pilgrim Hospital, Boston. She died days later, an inquest heard.

Coroner Prof Robert Forrest said it was “sub optimal” that work to clot her blood to stem the bleeding had not been carried out earlier, although this did not contribute to her death.

Mrs Coupland (82), of Winsover Road, Spalding, 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 she was fit for the procedure, despite having previous problems with blood clotting. Complications led to 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 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. On January 17 it was revealed she 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, Mr 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.”