A fireman died two weeks after a rare operation to remove his bowel which had moved up into his chest following a road accident 10-years earlier, an inquest heard tonight.
An experienced consultant anaesthetist at Dublin's St James's Hospital said he had never encountered an incident like this before despite working in one of the biggest thoracic surgery centres in America.
Brian Dempsey (31) from the South Circular Road in Dublin, was admitted to the accident and emergency department of the hospital on May 28th, 2003 complaining of chest pains.
A statement from Dr Vincent Young stated a chest x-ray revealed the entire left side of his chest cavity was full of his bowel. Mr Dempsey had suffered a major road accident almost 10 years previously, the inquest heard.
Doctors believed he had suffered a ruptured diaphragm at the time of the accident and an operation was carried out on June 3rd 2003 to return his bowel contents to his abdomen after he reported to St James's A&E.
Dr Tom Ryan, a consultant anaesthetist at the hospital, described it as a complex and unusual problem. He said he had worked in one of the largest thoracic surgery centres in the US.
"I never saw someone report 10 years after an accident with that, I just hadn't seen anything like this before."
Dr Ryan said problems like this were normally picked up at the time of accidents and repaired. "I had not seen before someone 10 years removed with a large diaphragmatic hernia," he said.
Dr Stuart Carr, who was a senior house officer in the emergency medicine training scheme, said he reviewed Mr Dempsey at 6.30pm with Dr Ryan when he was returned to the High Dependency Unit following the thoracic surgery.
He said there were no problems identified at the time.
It was noted in the following hours that Mr Dempsey's blood pressure was low, there were problems with his potassium levels and a low urine output.
Doctors said they prescribed more fluids as it was believed he was dehydrated following the operation.
Mr Dempsey initially responded well to treatment his urine and blood pressure levels dropped to alarming levels between 4am and 5am. His abdomen was found to be firm and they were concerned a small bowel obstruction or other difficulties had occurred.
An operation carried out that morning revealed the repair to the diaphragm had broken down and a part of his bowel had re-entered his chest cavity.
It was found the blood supply had been cut off to parts and they had to be removed. Dr Ryan said: "This is a very unusual operation, and a very unusual complication of a very unusual operation."
Mr Dempsey then underwent further surgery on a number of occasions before his organs began to fail and he died on June 24th, 2003.
The inquest was adjourned for the jury to consider its verdict on March 13th.
PA