The following are the conclusions of the State Pathologist in the case of Francis Sheridan.
1 Post-mortem examination showed that this young child had died from complications of recent surgery.
2 She had had an appendicectomy three weeks earlier. This appears to have been healing well and would not have been expected to cause any residual problems and certainly would not have been expected to lead to the child's death.
3 As a result of the natural healing process, scar tissue is formed at sites of surgery.
On occasion, during the healing process, adjacent healthy tissues can become incorporated into the healing wound, which then will remain attached to the operation site by strands of fibrous scar tissue known as adhesions.
In the majority of cases this has no ill effects and the person remains healthy.
However, in a very small proportion the fibrous bridges of scar tissue (adhesions) can create artificial spaces or closed loops, through which segments or lengths of bowel may slide. This is known as an 'internal hernia'.
In the early stages the bowel can slide in and out of the 'loop' and escape from the 'hernia' but the bowel may eventually become trapped, or incarcerated.
Once trapped in the 'hernia' the bowel may
then become strangulated, i.e., the blood supply to the incarcerated loop is compromised, causing
the trapped bowel to become ischaemic and necrotic.
Also once the bowel becomes trapped within the hernial sac, the bowel lumen is obstructed and food cannot pass along the bowel. Intestinal obstruction causes abdominal pain and distension, vomiting, constipation and failure to pass flatus (wind).
The bowel proximal to the obstruction (nearer the mouth) becomes dilated due to continuing intake of food, fluid and air.
4 At first the symptoms are sporadic as the internal hernia obstructs and then reduces, the bowel sliding in and out of the loop. If examined when the hernia has reduced there will be no sign of obstruction.
When the abdominal pain becomes constant this indicates that a segment of the bowel is trapped. At this stage signs and symptoms of obstruction will be present.
5 This condition can be rectified by further intra-abdominal surgery.
6 Unfortunately for this young girl the trapped bowel had become permanently trapped, or incarcerated, and there was already evidence of compromise of the vascular supply, early strangulation. Obstruction of the bowel was associated with vomiting and she had arrested after inhaling vomit, which is highly irritant to the airways.
7 Once the bowel is obstructed and is followed by vomiting the person may be at risk of inhaling vomit, particularly when lying down, e.g, when in bed, and also if drowsy or sleeping.
8 The formation of adhesions is part of the normal healing process and is not an indication of poor or negligent surgery. The wounds were healing well and the surgery otherwise had been a success.
CAUSE OF DEATH: (a) Inhalation of gastric contents, due to (b) small bowel obstruction, due to (c) adhesions post-appendicectomy.