Man died after suffering perforated organ, inquest hears

The inquest is being held at the Council House in Nottingham

A man died after suffering a perforated internal organ during a hospital procedure, an inquest has heard.

William Doleman, 76, went to Queen's Medical Centre in Nottingham on 19 March 2020 for an endoscopic retrograde cholangiopancreatography (ERCP).

He was discharged later that day, but readmitted to hospital days later with abdominal pains, and died on 1 April that year.

Muthuram Rajaram said the patient appeared fine after the procedure.

Nottingham Coroner's Court is hearing evidence relating to the deaths of Mr Doleman and three other patients treated by Dr Rajaram between April and November 2020.

Anita Burkey, Carol Cole and Peter Sellars also died after having surgical procedures performed by the gastroenterologist.

The inquest, which resumed on Tuesday, heard Mr Doleman had been admitted to hospital in July 2019 after suffering abdominal pains.

Despite doctors suspecting he had gallstones, no evidence was found on scans that took place in November.

An ERCP - where a tube is passed through a patient's throat to examine possible gallstones and other conditions - took place four months later, but on 22 March the patient was readmitted and a perforation to his duodenum was discovered.

A cause of death was given as acute respiratory distress syndrome (ADRS) and duodenal perforation, with conditions such as chronic obstructive pulmonary disorder and ischaemic heart disease also mentioned as contributory factors.

'A difficult procedure'

Consultant pathologist Ian Scott told the court an autopsy found evidence of perforation, as well as inflammation of the gallbladder, but "nothing concrete" proving he had had gallstones.

He said evidence Mr Doleman developing sepsis from the ERCP perforation was "the most likely source of infection", but another source of infection could also have occurred.

"Once he's developed sepsis he's at great risk of not surviving," he said.

Dr Rajaram said an ERCP was booked in as a "therapeutic procedure" to relieve Mr Doleman of his "ongoing symptoms", and it was conducted alongside Professor Dileep Lobo, who was supervising.

He told the court he explained to Mr Doleman the risks and benefits of the operation beforehand, but said he was not aware the patient had duodenal diverticula - pouches outside the duodenum that would make the ERCP "a difficult procedure".

While accepting a perforation occurred during the ERCP, he denied a "black defect" shown in photographs to the court were evidence of a perforation.

He said Mr Doleman did not show any symptoms of having suffered a perforation after the procedure.

"The patient would have had experience of pain immediately afterwards," he said.

Prof Lobo said Mr Doleman's underlying conditions meant "surgery was not the first option", but said performing an ERCP was "justified" due to concerns over his medical history.

"We had enough evidence to suggest there was something going on with [his] bile duct to proceed with the ERCP," he said.

Prof Lobo also said he did not believe the "black defect" was the site of perforation, saying he believed it was part of a diverticulum.

"A perforation of that size is very unlikely to be missed," he said.

The inquest covering all four deaths is expected to continue for three weeks.

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