A TEWKESBURY woman never regained her health after undergoing a hysterectomy 11 months before she died, an inquest heard.
Antoinette Jane Jones, aged 59, of Churchill Grove, Newtown, Tewkesbury, died at Cheltenham General Hospital on November 7, 2009.
She had agreed to surgery in December the previous year. Despite the operation being ‘uneventful’, she suffered a series of medical problems, and her health declined throughout 2009.
Gloucestershire deputy assistant coroner Katy Skerrett said the inquest considered two main issues: whether Mrs Jones had received the correct treatment, and should signs of possible kidney disease have been acted on sooner.
Mrs Skerrett said these issues had been thoroughly investigated and whether they had any effect on the eventual outcome remained ‘pure conjecture.’ The coroner recorded a narrative verdict and said it was not appropriate to add any rider of neglect as ‘there was no gross failure apparent in the treatment of Mrs Jones.’ Husband, Graham Jones, told the inquest his wife elected to have the operation, on a prolapsed womb, as she was uncomfortable and found it difficult to sit. When a hysterectomy was proposed, she was happy to go along with it, he said.
Mrs Jones underwent the hysterectomy on December 10, 2008, made a steady recovery and was discharged, but then readmitted to hospital on December 25 with blood clots and a possible infection.
She underwent further surgery to treat a fistula and, later, she suffered swelling, rashes and ulcers on her legs and body over the ensuing months.
In October 2009, she was referred to the specialist renal team, but her condition deteriorated and Mrs Jones died in hospital in November.
Consultant urogynaecologist David Holmes, who carried out the hysterectomy on Mrs Jones, said the operation was uneventful. There was slightly more bleeding than normal, but this was not out of the ordinary in procedures of this type.
Mrs Jones made a slow recovery, he said, but was discharged normally. However, she was readmitted on Christmas Day.
Mr Holmes said he attempted to remove two blood clots that had formed. This was not an unusual occurrence after a hysterectomy operation.
Mrs Jones developed multiple problems and was admitted to the intensive care unit.
Tests revealed she had developed a fistula leading from her colon and was suffering with blood poisoning. Her care passed to colorectal specialists on February 19.
Mr Holmes said: “This was an extremely unusual situation. The operation, and post-operative recovery, were entirely within normal limits, other than she was not well. We never really got a handle on why that was.”
When questioned by David Regan, counsel for the family, Mr Holmes said he had seen no evidence before the hysterectomy of Mrs Jones having a mild bleeding disorder.
Colorectal consultant Dr James Wheeler said he carried out an operation on the fistula on February 9. The operation was technically straightforward, he said, and Mrs Jones made a steady recovery.
Dr Wheeler said he saw Mrs Jones before her discharge, and again in April and September, when she was making only slow progress.
Professor Anthony Warrens, professor of renal and transplant medicine, reviewed the medical papers and said there was no evidence of Mrs Jones having a kidney problem when she underwent the hysterectomy.
He said that from the time of the fistula operation in February, there was a slow deterioration in her kidney function and the diagnosis of kidney disease in November 2009 was made too late.
When questioned by the coroner, Professor Warrens said it was 'entirely possible' that the diagnosis could have made in February.
Dr Susan Smith, consultant in anaesthetics and critical care, said that when Mrs Jones was in the intensive care unit, blood poisoning and not a kidney problem were causing low levels of the protein albumin in her blood.
When questioned by Mr Regan, Dr Smith said Mrs Jones had a normal kidney function at the time, a scan revealed her kidneys were of normal size, and she would have consulted a renal specialist if the results had been abnormal.
Consultant gynaecologist Martin Stone reviewed the medical papers and said it was clear there was no mention of a minor blood disorder from her or her family before the hysterectomy.
It was an entirely standard procedure and completely appropriate, he said. He agreed the bleeding during surgery was nothing unusual and it was controlled during the operation.
Consultant gastroenterologist Dr Michael Glynn, after reviewing the papers, said that in January and February the likely cause of the low albumin was blood poisoning. But the unusually low figure was a clue that a double process - blood poisoning and kidney disease - was taking place.
Forensic pathologist Dr Andre Davison carried out a post mortem examination and said that Mrs Jones died from multiple organ failure of heart, lungs, kidneys and liver caused by heart disease and low albumin levels, against a background of post-operation complications and kidney problems.
The coroner recorded a narrative verdict: “The deceased suffered multi-organ failure caused by hypertensive heart disease and low albumin concentrations. A combination of fibrillary glomerulonepluritis (kidney disease) and intra-abdominal sepsis caused the low albumin.
“The sepsis arose from post-operative complications following a hysterectomy performed in December 2008.”