Man died after rare operation on 10-year-old injury

A firefighter died after a rare operation to repair a serious injury he suffered during a road collision but which went undetected for a decade, an inquest has heard.

Brian Dempsey (31), South Circular Road, Dublin, died in St James's Hospital in June 2003 after he failed to recover from an unusual surgical procedure to treat a ruptured diaphragm.

He was admitted via the hospital's accident and emergency department complaining of abdominal pain on May 28th. He told doctors that he had been involved in a road crash 10 years earlier and had suffered intermittent abdominal pain since then. A chest X-ray revealed his entire left chest cavity was full of his bowel.

Doctors believed he had suffered a ruptured diaphragm at the time of the accident and an operation was carried out on June 3rd to return his bowel contents to his abdomen.

The inquest focused on the night of June 3rd, during a period Mr Dempsey spent in the hospital's high dependency unit after undergoing this operation. Though he did not die until two weeks later, it was on that night that the most significant deterioration in his condition occurred.

Noelle Fleming Northrop, clinical nurse manager in the intensive care and high dependency unit at St James's Hospital, said that following laparotomy surgery, Mr Dempsey was awake but was suffering from low blood pressure, low urine output, high potassium levels and acidosis.

Despite general stability in his condition and certain signs of improvement during the night, medical staff noticed a "very dramatic decline" in his condition after 5am. While his initial symptoms were those typically present in post-operatic patients and presumed to be the result of dehydration, it was later decided by doctors that his deterioration was the result of a surgical problem.

His abdomen was found to be firm and medical staff 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.

Mr Dempsey underwent further surgery on a number of occasions before his organs began to fail and he died on June 24th.

Dr Thomas Ryan, consultant anaesthetist at the hospital, said a problem such as Mr Dempsey's was normally picked up at the time of a collision and repaired.

"This is a very unusual operation and it's a very unusual complication of a very unusual operation," he said. "I never saw somebody presenting with a ruptured diaphragm after several years. I just hadn't seen anything like this before."

The inquest was adjourned until March 13th.