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A recent article in the British Journal of Surgery states that there have been increasing numbers of legal claims being made against the NHS in relation to bile duct injuries ‘in spite of 30 years of experience and training’. Bile duct injury is a dangerous complication of cholecystectomy – a common abdominal operation to remove the gallbladder, usually in order to treat gallstone disease.
Bile ducts are like drainage pipes – they carry bile from the liver to the gall bladder and then to the small intestine. If damaged, this can lead to different complications, such as chronic cholangitis (inflammation in the bile ducts possibly leading to bile leaking into the organs) and, potentially, the requirement for liver transplantation. The impact on long-term quality of life can be considerable. Bile duct injuries can cause sepsis, multi-organ failure and ultimately can be fatal. According to the World Society of Emergency Surgery (WSES) the most severe biliary injuries often occur after converting from a laparoscopic (keyhole) procedure to an open cholecystectomy.
As lawyers specialising in medical negligence, we are concerned that claims in this area have continued to rise. Bile duct injury is the most commonly recognised complication of cholecystectomy, occurring in 0.5% – 1.4% of cases. Where an injury is a recognised risk of surgery, its occurrence does not necessarily mean that there has been negligence and that a claim for compensation can be pursued. Here we look at the circumstances in which a medical negligence claim may be able to be successfully brought for a bile duct injury.
The likelihood depends on the facts relating to the particular injury and independent evidence from an expert clinician is almost always required in order to prove a claim. Some potential situations where a claim may arise include:
Surgical Technique
- If the bile duct injury was caused by poor surgical technique then a claim may be possible. An example could be failing to properly protect the duct during surgery, leading to it be being damaged.
Injuries can occur in multiple different ways including dislodged surgical clips or tearing. A severe bile duct injury can occur if the common bile duct is mistaken for the cystic duct and transected (cut). According to the BJS article laparoscopic cholecystectomy can be a complex operation and this can be worsened where there have been delays in treatment. The surgery should never be considered simple or routine. It requires an ‘experienced UGI surgeon or supervision by a Consultant’.
WSES guidelines highlight the importance of an exhaustive preoperative work-up prior to cholecystectomy in order to detect risk factors and choose the best surgical approach. There are increased risks where there is inflammation present.
Prompt Recognition and Management
- Early recognition of a bile duct injury is very important as surgical repair may be needed, potentially by way of open surgery.
Symptoms of such an injury post operatively can include fever, abdominal pain and nausea. A bile duct stricture can develop which causes a narrowing of the duct due to scar formation. This prevents the bile from properly draining into the intestine and it can then enter the bloodstream causing jaundice.
If the bile duct injury should have been recognised during surgery or shortly afterwards but was not, then there may be a claim. The longer the delay, the more unwell a patient may become. Correct management is vital.
- Additionally, if the bile duct injury is recognised but not treated correctly then a claim may be possible.
Obtaining Proper Patient Consent
- Even if an injury was not caused by a problem with surgical negligence, and came about as a recognised risk of the surgery, there may still be grounds for a claim if a patient was not properly informed about the risk. Such claims are complex and it would need to be shown that had the patient been given full information they would not have proceeded with the surgery at that time or at all. There is more information about claims for a lack of informed consent here.
When bringing a clinical negligence claim, it has to be shown not only that the care provided was negligent but also that the identified negligence was the cause of the injury. To prove this requires specialist independent expert evidence. Compensation can be claimed for the impact of a negligently caused injury. This may include a claim for the care that the patient will require going forward for example where a patient is going to require a liver transplant. Where a patient is unable to work as a result of their injury then compensation may include lost earnings and lost pension. The impact of the negligently caused injury can also have damaging psychological consequences for the patient.
The Kingsley Napley Team are specialists in claims relating to surgical negligence and can provide full advice.
If you or a loved one have suffered a bile duct injury and are seeking legal advice, please contact our friendly and sensitive team for a no obligation discussion on 020 7814 1200 or via our contact us page.
Further information
If you have any questions regarding this blog, please contact Sharon Burkill or Kirsty Allen in our Medical Negligence & Personal Injury team.
About the authorS
Sharon Burkill has undertaken a wide variety of medical negligence cases over the past 20+ years; her main areas of specialism include investigating negligence claims arising at or around the time of birth, or during neonatal care, and she regularly represents both parents and injured babies/children following a diagnosis of cerebral palsy, or other acquired brain injuries.
Kirsty Allen is a highly experienced medical negligence solicitor who undertakes a wide variety of cases with particular specialisms in child cerebral palsy and adult brain injury cases, fatal claims, loss of sight cases, as well as failure to diagnose cancer and gynaecological claims.
We welcome views and opinions about the issues raised in this blog. Should you require specific advice in relation to personal circumstances, please use the form on the contact page.
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