A jury has found that a young Co Roscommon woman died from Sudden Adult Death Syndrome (SADS) "which may have been contributed to by the trauma of a recent gallbladder operation".
Following a six and half hour inquest at the Coroners' Court in Ballaghaderreen, the jury returned a verdict of death by natural causes in the case of 23-year-old Katie Ryan from Ballinagare, Castlerea. The young woman died on December 9th, 2016, a month after having her gallbladder removed at Mayo University Hospital (MUH).
Ms Rita Kilroy, counsel for the Ryan family had told the jury they believed that the cause of death was sepsis and not SADS.
Corner Brian O'Connor heard conflicting medical evidence as to the cause of death. He was told that Katie, described by her mother as "a vibrant vivacious girl who loved life" had her gallbladder removed in MUH on November 8th, 2016 and was discharged after two days.
But she was re-admitted to hospital complaining of severe pain which she rated at eight out of 10, on November 17th.
According to the hospital nursing notes Katie collapsed on the ward while walking back from the toilet on the morning of November 18th. Nursing staff also recorded that at 10am that morning she was pale and in pain. At 1.30pm she was unable to walk due to pain, according to the notes.
After scans, and a series of blood tests which were described as being within the normal range, she was discharged the following day.
Hairdresser
Katie’s brother Terence (Terry) Ryan told the jury that she had stayed with him at his home in Ballaghaderreen on the night of December 8th, 2016. She was back working three days a week as a hairdresser at this stage. She had been shopping with her mother and sister in Galway that day. They had gone to the Christmas market and she had gone on the Ferris Wheel, after buying a ticket for her mother who would not go on it.
Mr Ryan recalled that he went to call Katie the next morning at 8.30am. He knocked on her door and went into her room when there was no reply. When he turned on the light he saw that her forehead was very white and her eyes were open. She was unresponsive and he dialled 999. The jury heard that Katie was pronounced dead at the scene by local GP Dr Martin Garvey at 9.35am.
A statement from Dr Waqar Khan, a consultant surgeon, who had examined Katie when she was re-admitted detailed that an ultra sound and another scan known as an MRCP were done, as well as a series of blood tests. There was no evidence of a stone in the bile duct.
Ms Kilroy applied for an adjournment to hear direct evidence from Dr Khan who is currently out of the country but the Coroner refused to grant an adjournment.
Dr Helen Ingoldsby who carried out the post mortem found that the cause of death was SADS. Questioned by Ms Kilroy on whether she had reached her conclusion by default she agreed it was “a diagnosis of exclusion”.
Dr Ingoldsby confirmed that she did have access to Katie’s blood test results but not to the medical notes from the hospital. She told the jury that she did not see any evidence of pus or inflammation.
Gene mutation
Prof Andrew Green , Professor of Medical Genetics at University College Dublin, said he had carried out tests and had found evidence that Katie had a gene mutation which made her predisposed to cardiac arrhythmia. Under cross-examination, Prof Green said he was aware that the issue of sepsis had been raised and it was “difficult to know for certain what happened on the night she died”.
Dr Elizabeth Soilleux, a UK-based consultant pathologist and international expert on SADS, told the jury she had reviewed the post mortem results, the medial notes and some post mortem photographs .
She did not agree with Dr Ingoldsby that there was no pus present. She said there was significant evidence of inflammation. She believed not enough testing had been done to exclude infection as a cause of death.
Her findings were that the cause of death was sepsis but she told Mr Rory White, counsel for MUH, that given the evidence of a gene mutation, sepsis could have “tipped her over the edge” and caused the arrhythmia.
Uneventful surgery
According to witness Professor Kevin Barry who had performed the surgery, the medical notes showed that the bloods were in the normal range.
Prof Barry told the jury that the surgery on Katie was uneventful. He reviewed her that evening on his ward rounds and again the following morning. He considered her medically fit to be discharged on November 10th.
The consultant surgeon was abroad when the young woman was re-admitted on November 17th. He said if there were complications after such surgery he’d expect them to manifest themselves within three to five or possibly six days.
Had he been in the hospital when she was re-admitted “I would not be planning to bring her back to the operating theatre on the basis of the MRCP(scan)”.
Prof Barry said all the blood test results were within the normal range for an adult. He said he had never dealt with a situation where a patient had died from sepsis five weeks after a gallbladder operation.
“That is not how it behaves clinically,” he said. The consultant said a patient would deteriorate very quickly if there was sepsis in the abdomen relating to surgery .
Speaking after the verdict, Mrs Ryan said she was grateful to the jury for acknowledging that the surgery played a role in her daughter’s death.
“All we want is to find out what happened,” she said.
Mrs Ryan said her daughter had been a happy vibrant young woman who loved life.
“As long as she had lipstick and a new dress she was happy”.
The family said they were devastated to lose her so suddenly.
