Baby's bladder removed by mistake
A 18-month-old girl will need to use a catheter for the rest of her life after a botched operation in which 90 per cent of her bladder was mistakenly taken out by a surgeon, a disciplinary hearing was told today.
Pierina Kapur, 43, was supposed to remove a hernial sac from the youngster but mistook it for her bladder.
The girl, then aged seven weeks, was admitted to Royal Manchester Children's Hospital for repairs to hernias on both sides of her stomach, with an ovary embedded on her left side.
Following the operation she was rushed to intensive care after concerns she had not passed urine for 35 hours and had developed a temperature and a rash.
The General Medical Council allege Miss Kapur's actions caused "irreparable damage" to the lower urinary tract.
The patient, known as Baby A, has undergone several operations since and will need more as she has to permanently rely on a tube to pass urine, a Fitness to Practise panel was told.
Miss Kapur admits her role in the operation was "inadequate" and below the standard to be expected of a reasonably competent consultant paediatric surgeon, but she denies misconduct.
Catherine Cundy, representing the GMC, said Baby A was admitted with the hernia problem and constipation on October 2, 2008.
"The left ovary was protruding through her stomach and was palpable," she said.
Miss Kapur set out to remove the large, left inguinal hernial sac, which a colleague - who worked on the right side of the stomach - considered to be a "very difficult" procedure.
She then completed the operation by closing up the abdomen and conducting a rectal biopsy before Baby A was returned to the ward.
Miss Cundy said: "In the course of the evening Baby A became more unsettled, she developed a temperature and a rash, was not feeding properly and had not passed urine since the operation."
Fluids were prescribed but an on-call locum consultant paediatrician was summoned when the baby had not passed urine for 30 hours post-operation.
Attempts to fit a catheter repeatedly failed as more fluids and anti-biotics were given, she said.
Five hours later the rash had spread and blood tests were ordered which later confirmed she had dangerously high levels of potassium.
An initial ultrasound of the girl's abdomen could not identify a full bladder and she was rushed to intensive care where evidence of acute renal failure was indicated.
A consultant paediatric urologist needed two attempts to insert a tube into her stomach to drain her kidneys.
Miss Cundy said: "During this second and lengthy operation he observed that 90 per cent of Baby A's bladder had been removed, both ureters had been damaged, that the urethra had been closed off and the left inguinal hernia which should have been removed or repaired was still intact and still had the left ovary in it."
She said Baby A needed further operations to deal with the problem and the risk of infections also had to be monitored.
She said: "She will have to undergo further operations. She will depend on catheterisation for the rest of her life."
The GMC said the panel will hear from its expert witness that the operation was "severely sub-standard and grossly negligent".
Miss Kapur, a consultant paediatric and neonatal surgeon, conceded the operation caused damage to both ureters - tubes which propel urine from the kidney to the bladder - and had severed the left ureter from the bladder.
She denies that following the operation she did not take steps to arrange for an ultrasound scan of Baby A's abdomen and urinary tract, and blood tests to check Baby A's kidney function.
The hearing in Manchester continues.
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