Perforated Ulcer Misdiagnosis Claims

What a perforated ulcer is

An ulcer is an open sore that can develop on the inside lining of your stomach or the upper part of your small intestine. While many ulcers are managed with medication, a "perforation" occurs when the ulcer burns completely through the wall of the stomach or bowel. This creates a hole that allows stomach contents to leak into the abdomen.

There are two main types of peptic ulcers involved in these cases:

• Gastric Ulcers: These form inside the stomach itself. They are often linked to factors like H. pylori bacteria or the long-term use of anti-inflammatory drugs (NSAIDs).
• Duodenal Ulcers: These form in the duodenum, which is the first part of the small intestine just past the stomach. These are actually more common than gastric ulcers and can also perforate if they are not treated effectively.

Why this becomes a medical emergency

When an ulcer perforates, it is becomes a surgical crisis. The leakage of stomach acid, food, and bacteria into the abdominal cavity causes peritonitis.

In plain English, peritonitis is a severe infection and inflammation of the lining of your tummy. If the hole is not repaired and the abdomen is not washed out quickly, this infection can spread to the blood, leading to sepsis. Sepsis is a life-threatening reaction to infection that can damage tissue and shut down organs. Every hour of delay increases the risk of serious complications, which is why timely recognition by medical staff is critical.

How perforated ulcers are commonly misdiagnosed or missed

Diagnosing a perforated ulcer can be challenging, but medical professionals are trained to look for specific warning signs. Unfortunately, because the early symptoms can resemble common tummy bugs, patients are sometimes misdiagnosed with less serious conditions like indigestion, acid reflux, gastritis, or a viral vomiting bug.

Several factors can contribute to these diagnostic errors:

• Assessment issues: A doctor may fail to take a full medical history (such as asking about previous ulcers or painkiller use). Crucially, a failure to perform a proper physical examination can mean missing the "rigid" stomach that typically signals a perforation. Sometimes, vital signs like a fast heart rate are dismissed as simple anxiety rather than a sign of infection.
• Testing and escalation issues: Even if a doctor suspects an issue, delays can happen if urgent imaging (like an X-ray or CT scan) is not ordered or if the scan is delayed for hours. In some cases, test results show signs of inflammation, but they are not acted upon, or a request for a surgical review is made but not followed up with urgency.

Signs and symptoms that should prompt urgent assessment

While pain can vary from person to person, there are typical patterns that doctors should recognise as potential red flags for a perforated organ.

Typical symptoms patients report:

• Sudden, severe pain: Unlike the slow build-up of a tummy bug, this pain often hits suddenly and sharply (often described as "thunderclap" pain).
• Spreading pain: It may start in the upper stomach but quickly spreads across the entire abdomen.
• Pain moving to the shoulder: This is known as "referred pain" and happens when the leaking stomach contents irritate the diaphragm.
• Worsening with movement: Patients often lie perfectly still because any movement, even coughing or the bumps on the road during the ambulance journey, causes agony.

Red flags clinicians look for:

• Rigid abdomen: The stomach muscles become hard and tight (board-like) when touched.
• Rebound tenderness: Pain that worsens when the doctor releases pressure on the abdomen.
• Signs of shock: Low blood pressure, a fast heart rate, or a fever indicate the body is fighting a serious infection.

What appropriate assessment and diagnosis often involves

When a patient arrives with severe abdominal pain, there is a standard of care that medical professionals are expected to follow. This does not mean they must be perfect, but they must take reasonable steps to rule out life-threatening conditions.

Key steps in a reasonable assessment typically include:

• History-taking and physical examination: The doctor should ask about risk factors (like smoking or NSAID use) and physically feel the abdomen to check for rigidity or guarding.
• Common investigations:
  • Blood tests: To check for elevated white blood cells or CRP (markers of infection) and lactate levels (a sign of sepsis).
  • Imaging: An erect chest X-ray is often done first to look for "free air" under the diaphragm (escaped gas). However, if the X-ray is normal but symptoms persist, a CT scan is usually required for a definitive diagnosis.
  • Endoscopy caution: While endoscopy is used to find ulcers, it is generally avoided if a perforation is already suspected, as pumping air into the stomach could make the hole worse.
• Documenting decisions: If a doctor decides to send a patient home, they should clearly document why they believe it is safe to do so and provide specific "safety-netting" advice on when to return.

Outcomes that may follow a delayed diagnosis

The outcome of a perforated ulcer is closely linked to how quickly surgery is performed. When caught early, a simple keyhole repair might be enough. When missed, the damage can be extensive.

Short-term complications:

• Severe Sepsis: The body’s response to the infection can lead to organ failure (kidneys, lungs, or heart).
• Emergency Open Surgery: Instead of a small keyhole procedure, a large incision (laparotomy) may be needed to wash out the severe infection.
• Intensive Care (ICU): Patients often require ventilation and life support if the infection has spread.

Longer-term impacts:

• Prolonged Recovery: A hospital stay of days can turn into weeks or months.
• Stoma bag: In severe cases where the bowel is too inflamed to stitch together, a surgeon may need to create a temporary or permanent stoma.
• Abdominal adhesions: Internal scarring from the infection and major surgery can cause chronic pain or future bowel blockages.

When a misdiagnosis may raise a medical negligence issue

Not every missed diagnosis is considered negligence. Medicine is complex, and sometimes symptoms are not clear. However, a claim may arise if the care provided fell below an acceptable standard.

• The standard of care (Dunne Principles): In Irish law, medical negligence is assessed using the Dunne Principles. Simply put, to prove negligence, it must be shown that the doctor failed to do what other doctors of ordinary skill would have done in the same situation. If a regular, competent doctor would have ordered a CT scan given your symptoms, and your doctor did not, there may be a case for negligence.
• Causation: It is not enough to prove a mistake happened; we must also prove "causation." This means showing that the delay directly caused you more harm than you would have suffered otherwise. For example, if the perforation was diagnosed 12 hours late, did that delay cause the need for a stoma or a longer ICU stay? We assess this by comparing the likely outcome of prompt treatment versus the actual outcome you experienced.

To prove these points, we engage independent medical experts (usually from the UK to ensure neutrality). A consultant surgeon or GP will review your notes and provide an opinion on whether the care was negligent and if it caused your injuries.

Evidence that is typically important in perforated ulcer misdiagnosis cases

To build a clear picture of what happened, we need to gather specific evidence. The most vital pieces of information are your medical records. We will request records from your GP, the out-of-hours service, the ambulance service, and the hospital (including A&E triage notes and nursing notes).

Key evidence we look for includes:

• Tests and Imaging: We look at the timeline. When was the blood test ordered? When were the results ready? Did a doctor review them promptly? If an X-ray was done, was the report accurate, or was the "free air" missed?
• Practical supporting evidence:
  • Symptom timeline: Your own account (or your family's) of when the pain started and how it changed.
  • Medications: A list of painkillers you were taking, which might have masked symptoms or contributed to the ulcer.
  • Follow-up advice: If you were discharged, what instructions were you given? Were you told to come back if the pain got worse?

How the process works in Ireland

We know that taking legal action can feel daunting. We aim to make the process as transparent and stress-free as possible.

• Initial fact-finding and record gathering: Our first step is to listen to your experience. We will then take up your medical records from all relevant healthcare providers. We organise these records chronologically to understand exactly who saw you, when, and what decisions were made.
• Expert review and pre-action steps: Once we have your records, we send them to an independent medical expert for review. If the expert confirms that the care was negligent and caused avoidable harm, we will send a "Letter of Claim" to the defendant (usually the HSE or the hospital’s insurers) setting out the allegations.

Time limits for medical negligence in Ireland

It is crucial to act quickly due to the strict time limits imposed by the Statute of Limitations.

The two-year limit and "date of knowledge"

Generally, you have two years to issue legal proceedings. This clock usually starts from the date of the injury. However, in misdiagnosis cases, you might not know a mistake was made until later. In these cases, the two years may start from your "date of knowledge",the date you first realised (or should have realised) that your injury was caused by a medical error.

Exceptions for children

If the patient is a child (under 18), the time limit is paused. The two-year "clock" only begins to run on their 18th birthday. This means they have until the day before their 20th birthday to bring a claim, although parents can bring a claim on their behalf at any time before then.

For precise advice on time limits, please contact us directly, as exceptions can be complex.

Perforated ulcer misdiagnosis FAQs

Can a perforated ulcer be missed on a first A&E visit?

Yes. If the perforation is small or temporarily plugged by food or tissue, the symptoms might not look "classic" immediately. However, if red flags like a rigid abdomen or abnormal vital signs were present and ignored, it may still be considered negligence.

What if I was told it was indigestion or gastritis and sent home?

This is a common scenario in misdiagnosis claims. If you were sent home with a diagnosis of gastritis but actually had a perforation, we investigate whether the doctor did enough to rule out the more serious condition before discharging you.

What medical records should I request first?

You do not need to request these yourself; we handle this for you. We will request your complete file, including handwritten clinical notes, nursing charts, discharge summaries, and radiology reports.

How is "delay" assessed in a medical negligence context?

We look at the "breach of duty." If a competent doctor would have diagnosed you at 10:00 AM, but you were not diagnosed until 10:00 PM, the "delay" is 12 hours. We then assess what damage occurred specifically during those 12 hours.

What if I had H. pylori or was taking anti-inflammatories?

Having risk factors like H. pylori or taking NSAIDs does not prevent you from making a claim. In fact, these risk factors should have alerted the medical team to the possibility of an ulcer, making a missed diagnosis potentially harder to justify.

How long do I have to seek legal advice in Ireland?

You should seek advice as soon as possible. While the general limit is two years, investigating a claim takes time. Obtaining records and expert reports can take months, so contacting a solicitor early ensures your case is prepared well within the statutory limits.

How Michael Boylan LLP can assist

We are recognised as one of Ireland’s leading medical negligence firms. We understand the medicine as well as the law, and we ask the right questions from day one.

Our first meeting is about listening. We will discuss the timeline of events, the impact the injury has had on your life, and what you hope to achieve. We will explain the legal process in plain English and give you an honest assessment of whether we believe there is a case to investigate.

When gathering evidence, we leave no stone unturned. We work with a panel of highly respected medical experts who are leaders in their fields. We ensure that the experts we choose have the specific experience relevant to your case, whether that is emergency medicine, gastrointestinal surgery, or radiology.

Finally, we keep you updated at every stage in clear, neutral terms. You will always know what the next step is, how long it might take, and what is required from you. We are here to shoulder the legal burden so you can focus on your recovery.

Start the conversation today

If you or a family member has suffered due to a delayed diagnosis of a perforated ulcer, you need answers. Contact our specialist team today for a confidential discussion about your experience.

*In contentious business, a solicitor may not calculate fees or other charges as a percentage or proportion of any award or settlement.