Children's surgeon 'removed toddler's bladder after mistaking it for hernia'



A children's doctor cut out 90 per cent of a baby's bladder after she mistook the organ for a hernia during a bungled hospital operation, a medical tribunal heard today.

Consultant paediatric surgeon Dr Pierina Kapur, 43, failed to recognise the hernia when she carried out the operation on the seven-week-old baby girl, it was alleged.

Instead she removed almost all of the youngster's bladder by mistake then sewed up the remainder of it not realising what she had done.

The bungle emerged when the baby was taken into surgery with acute kidney failure and other doctors discovered both ureters - ducts by which urine passes from the kidney to the bladder - had been damaged.

Dr Pierina Kapur with her solicitor outside the General Medical Council in Manchester today. She is accused of cutting out 90 per cent of a baby's bladder after mistaking it for a hernia

The left hernia, protrubing through the muscle wall, was still intact, with the ovary still inside it.



The child, known only as baby A, was unable to pass urine for over 35 hours and will now require a catheter for the rest of her life with continued medical treatment for 'irreparable damage'.

Today at a medical tribunal in Manchester, Dr Kapur, who was employed by the Central Manchester and Manchester Children's NHS Trust admitted bungling the operation on October 2 2008.

But she denied that she had failed to take adequate steps after the operation to arrange for an ultrasound and to get blood tests to check the baby's kidney function.

She also denies that her fitness to practise had been 'impaired because of her misconduct'.

The tribunal heard that the left inguinal hernia operation - in the area around the groin - was considered 'difficult' as a large hernial sac needed to be removed with the baby's left ovary embedded in it.

Following the procedure, and subsequent rectal biopsy, at Royal Manchester Children's Hospital in Pendlebury, the child was transferred back to the ward.

Royal Manchester Children's Hospital where the operation took place. The child will need a catheter for the rest of its life, the hearing was told

But her mother became concerned over the course of evening as baby A had developed a facial rash, temperature and had not passed urine since before the operation.

Fluids were prescribed, but the baby was not reviewed again until 9am the following morning when further fluids were administered to try and ease the constipation.

The panel, sitting in Manchester, heard that the locum consultant surgeon was called to assess the child at 3pm that afternoon with Dr Kapur and a decision was made to insert a catheter.

Counsel for the GMC, Ms Catherine Cundy told the hearing, 'Miss Kapur appears to have left the hospital at this point.

'It is the GMC case that despite knowing that baby's symptoms and how difficult surgery had been, she did not take any or any adequate steps to arrange for blood tests or an ultrasound to be taken.'

By 8.30pm on October 2 2008, baby A had not passed urine for 35 hours and her rash had spread. She was re-examined and blood tests revealed she had 'dangerously high levels of potassium' in her blood.

An ultrasound could not detect a full bladder and the baby was transferred to paediatric intensive care at midnight.

The panel heard that she was taken into surgery with acute renal failure and exploration of her bladder revealed that 90 per cent of it had been removed, and that both ureters had been damaged.

The left hernia was still intact, with the ovary still inside it.

Ms Cundy added: 'You will hear from the baby's mother that she has had to undergo further operations and in-patient stays to try and deal with the aftermath of her original surgery and the repeated infections to which she is susceptible.

'She will need to undergo further surgery and will remain dependant on catheterisation for the rest of her life.

'You will hear from our expert witness that Miss Kapur failed to recognise the anatomy or stop and take a step back from what she had found therefore causing serious and irreparable damage to the bladder.

'He is critical of her failure to take appropriate steps to investigate the baby's post operative symptoms when she knew surgery had been unexpectedly difficult and lengthy.'

Dr Ian Hennessey who assisted Dr Kapur in the operation told the panel that a straight-forward operation to remove a hernia from a female infant would usually take 15 minutes, but this operation had taken 'just over an hour' because of the difficulties.

Dr Kapur of Greater Manchester admitted that she had failed to recognise the anatomy on the baby's left side, mistook the bladder for the left inguinal hernial sac, opened the bladder, dissected 90 per cent of it, obstructed the right ureter, failed to identify and operate on the left hernial sac with the left ovary embedded in it, caused damage to both urethers and severed the left ureter from the bladder.

She also admitted that she was aware of baby A's post-operative difficulties and accepted this was inadequate and substandard.

The hearing continues.