A Westmeath man suffered fatal bleeding while undergoing what a hospital consultant described as “low-risk” surgery to ease pressure on a nerve in his head, an inquest has heard.
Shane Kelly, 57, died from “torrential” bleeding during an operation at Beaumont Hospital in Dublin on October 1, 2020 to treat a condition known as trigeminal neuralgia, where a blood vessel is pressing against the nerve which provides sensation to the face. A sitting of Dublin District Coroner’s Court heard Mr Kelly, a baker from Mayfield Grove, Athlone, Co Westmeath, had opted for the elective surgery as he had “just wanted to live a pain-free life.”
Mr Kelly’s fiancée, Ruth Dwyer, said her partner had suffered debilitating pain in his head from the condition. Ms Dwyer said a neurosurgeon, Daniel Rawluk, who had seen Mr Kelly at the Hermitage Clinic in Dublin, had diagnosed him with trigeminal neuralgia in 2019 for which she was grateful as he had suffered chronic pain in his face since 2014.
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Ms Dwyer said the consultant had explained that the condition could be treated by either surgery or radiation. The witness became tearful as she recalled being “in absolute shock” after being contacted by Dr Rawluk on October 1, 2020 when he outlined how the father of four had passed away after suffering “torrential bleeding” during surgery at Beaumont Hospital.
Ms Dwyer said both she and the surgeon were emotional during the conversation. The witness told the coroner, Clare Keane, that she held no grudge against Dr Rawluk over what had happened.
In evidence, Dr Rawluk explained how he believed surgery known as vascular decompression to ease the pressure on Mr Kelly’s trigeminal nerve was the best option as the pain would be gone following the operation. The surgeon said the patient’s condition had been getting worse and he was suffering up to four facial spasms daily.
He explained how the pain, which could be like “a severe electric shock”, could be triggered by common actions such as talking, eating or shaving. Dr Rawluk said he had discussed with Mr Kelly the “extremely small” risk of the surgery which he explained in very rare cases could result in bleeding which could prove fatal.
He estimated such a risk as one in 10,000-20,000 cases. Dr Rawluk said he carried out 90% of such operations in the Republic which he had been performing for over 30 years.
He noted that trigeminal neuralgia was a condition that was often misdiagnosed. The surgeon said he conducted 20 operations of vascular decompression on average each year in both public and private hospitals.
In response to questions from Dr Keane, Dr Rawluk said nothing had shown up on an MRI scan of the patient before surgery to suggest there was “anything unusual”, while the operation itself had been “going extremely smoothly”. Dr Rawluk recalled how he could not control the patient’s bleeding after a vein “erupted” before Mr Kelly suffered a cardiac arrest from which he could not be resuscitated.
A pathologist who carried out a post-mortem on Mr Kelly’s body, Jane Cryan, attributed the cause of death to acute hydrocephalus – a condition where there is an abnormal build-up of spinal fluid in ventricles within the brain. Dr Cryan said it had resulted from bleeding which had arisen during surgery.
Based on the evidence, the coroner, Clare Keane, returned a verdict of medical misadventure. Dr Keane stressed that her verdict was not making any judgement but “reflecting the fact that it was the unintended outcome of an action taken.”
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