§ GUIDE · SCOPE AND KEYHOLE COMPLICATIONS

A scope or keyhole procedure went wrong,
and nobody caught it in time.

Perforation, a leak and pancreatitis are printed on the consent form for every one of these procedures. That is why a claim is rarely about the complication itself. It is about whether a preventive step was missed beforehand, or whether the warning signs afterwards were acted on quickly enough.

Judgments read

7

Claimant succeeded

4 of 7

Alexander: agreed sum

£550,000

Healey: settlement

£1.2 million

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§ BEFORE YOU GO FURTHER

For a complication claim to get anywhere, these things usually need to be true

  • You had a colonoscopy, gastroscopy, ERCP, a PEG feeding tube, or keyhole surgery on the stomach or bowel, and a perforation, leak, bleed or pancreatitis followed.
  • Either a preventive step was missed beforehand, or your pain, pulse, temperature or blood results afterwards pointed to the complication and nobody acted promptly.
  • The delay made things worse: more surgery, a stoma, intensive care, lasting damage, or a death that earlier action would probably have prevented.
  • It happened within the last three years, or you only recently learned that care fell short.

In Ward and Tarrant the complication was real and the consequences severe, and both claims still failed because the court found nothing the clinicians should have seen or done differently. The complication alone is not the claim.

§ 01

A preventive step that was never given.

Alexander v HCA International [2026] EWHC 1284 (KB) is the clearest recent example. A patient had an ERCP, the camera-guided procedure used to clear gallstones from the bile duct, at a private hospital. A suppository of diclofenac is the standard way of cutting the risk of pancreatitis after an ERCP. The judge found the consultant gastroenterologist never prescribed it or instructed anyone to give it, so it was not given. The patient developed life-threatening necrotising pancreatitis, spent months in hospital, had multiple operations and was left with an ileostomy, diabetes and chronic diarrhoea.

Judgment was entered against the consultant for the agreed sum of £550,000. The claim against the hospital itself was dismissed: the prescribing doctor, not the building, carried the liability. The lesson is that failing to give a recognised preventive drug before a procedure can be negligent on its own, whoever owns the hospital.

§ 02

The complication that was not recognised in time.

Healey v McGrath [2024] EWHC 1360 (KB)

Mr Healey died nine days after bowel cancer surgery at a private hospital when a leak at the surgical join was not recognised in time. The hospital settled the widow's claim for £1.2 million, and the court then ordered the surgeon to bear 75 per cent of it, finding his failure to diagnose the leak the principal cause of death.

Welsh v Walsall Healthcare [2018] EWHC 1917 (QB)

A 40-year-old had gastric bypass surgery and developed a leak that was not diagnosed until a day after clear warning signs. Yip J found the trust liable for several failings and assessed general damages alone at £100,000, with care and therapy costs on top.

MJF v University Hospitals Birmingham [2024] EWHC 3156 (KB)

A young woman with cerebral palsy had a PEG feeding tube inserted and was found unresponsive two days later with peritonitis and sepsis. The judge rejected the doctor's account of how the tube had been fixed, found it was placed under too much tension, and entered judgment for the claimant.

§ 03

When a perforation is not negligence.

Ward v Oxford University Hospitals [2023] EWHC 2803 (KB)

Mr Ward's stomach was perforated during keyhole removal of a gastric band. The hole was not seen during the operation and was repaired the following morning after he deteriorated. The judge found the perforation was not visible at the time, so there was no negligent failure to identify and repair it.

Tarrant v Monkhouse [2025] EWHC 2576 (KB)

After a sleeve gastrectomy the claimant had trouble swallowing. The surgeon performed a gastroscopy and balloon dilatation, after which the sleeve leaked. The judge found no breach of duty in the post-operative care or the dilatation and dismissed the claim despite the very serious consequences.

Deakin-Stephenson v Behar [2024] EWHC 2338 (KB)

Admitted with perforated diverticulitis, the claimant had a keyhole washout, deteriorated about 36 hours later and needed an emergency Hartmann's procedure with a stoma and intensive care. She said she had asked for a colorectal referral, was improperly moved to private care and was not properly consented. The judge found none of it proved.

§ 04

Where the line sits.

The legal test is the same as for any clinical negligence claim. Was there a step a responsible body of practitioners would have taken, and was it missed? Before the procedure that means recognised prophylaxis, as in Alexander. Afterwards it means a scan or a return to theatre when pain, pulse, temperature or blood results point to a leak or perforation, as in Healey and Welsh.

Timing is measured in hours. The observation charts, the blood results and the record of when the surgeon was told are what the experts work from. In Ward the repair the next morning was not negligent because nothing was visible earlier; in Welsh a day's delay after clear warning signs was.

Two further points. Where a private hospital is involved, both the hospital and the individual consultant can be liable and the court may apportion responsibility between them. And if you were told of the risk, it materialised, and no step was missed, the consent cases will not rescue the claim: see the guide on consent after Montgomery.

§ 05

What helps a claim.

  • The consent form and the information leaflet you were given, which fix what risks were explained.
  • The procedure report, including what was seen and whether anything was noted as difficult.
  • Observation charts after the procedure: pulse, temperature, blood pressure and any early-warning score.
  • Blood results, especially inflammatory markers and, for an ERCP, the pancreatic enzymes.
  • The time between your first complaint of pain and the scan or re-operation, and who was told when.
  • The discharge summary and any readmission notes.

§ THE JUDGMENTS BEHIND THIS GUIDE

The seven judgments behind this guide.

Four claimants succeeded and three did not. Every one is a published decision of the courts of England and Wales, linked to its source.

Claimant succeeded£550,000

Alexander v HCA International Limited & Anor

[2026] EWHC 1284 (KB)·2026·Liability decided at trial

A patient developed life-threatening pancreatitis after a gallstone-removal ERCP. The judge found the consultant never prescribed or instructed the standard preventive diclofenac suppository, so it was not given, and entered judgment for £550,000 against him.

Failing to give a recognised prophylactic drug before a procedure can be negligent even in private care. The prescribing doctor, not the hospital, carried the liability here.

Claimant succeeded£1.2M

Healey v McGrath & Anor

[2024] EWHC 1360 (KB)·2024·Liability decided at trial

Mr Healey died nine days after bowel cancer surgery at a private hospital when a leak at the surgical join was not recognised in time. The hospital settled the widow's claim for £1.2 million and the court ordered the surgeon to bear 75% of it, finding his failure to diagnose the leak the principal cause of death.

Post-operative deterioration after bowel surgery must prompt urgent consideration of a leak. Both the private hospital and the individual surgeon can be liable, with the court apportioning responsibility between them.

Claimant succeeded

Welsh v Walsall Healthcare NHS Trust

[2018] EWHC 1917 (QB)·2018·Liability and damages decided at trial

A 40-year-old had gastric bypass surgery and developed a leak that was not diagnosed until a day after clear warning signs. Yip J found the trust liable for several failings and assessed general damages at £100,000 plus care and therapy costs.

After weight-loss surgery, signs of a leak need to be acted on promptly; delayed diagnosis can turn a treatable complication into life-changing injury. General damages reflect the whole picture of pain, disability and psychological harm.

Claimant succeeded

MJF v University Hospitals Birmingham NHS Foundation Trust

[2024] EWHC 3156 (KB)·2024·Liability decided at trial

A young woman with cerebral palsy had a PEG feeding tube inserted and was found unresponsive two days later with peritonitis and sepsis. The judge rejected the doctor's account of how the tube was fixed, found it was placed under too much tension, and entered judgment for the claimant.

Where a clinician's recollection is unreliable and contradicted by the physical evidence, the court can find a procedure was done negligently. Causation may still be limited where a pre-existing condition would have deteriorated anyway.

Claim failed

Ward v Oxford University Hospitals NHS Foundation Trust

[2023] EWHC 2803 (KB)·2023·Liability decided at trial

Mr Ward's stomach was perforated during keyhole removal of a gastric band; the hole was not seen during the operation and was repaired the following morning after he deteriorated. The judge found the perforation was not visible at the time and so there was no negligent failure to identify and repair it.

A perforation missed during surgery is only negligent if there was visible evidence the surgeon should have seen. Post-operative pain that leads to timely re-operation may not give rise to a claim.

Claim failed

Tarrant v Monkhouse

[2025] EWHC 2576 (KB)·2025·Liability decided at trial

After a sleeve gastrectomy the claimant had trouble swallowing; the surgeon performed a gastroscopy and balloon dilatation, after which the sleeve leaked. The judge found no breach of duty in the post-operative care or the dilatation and dismissed the claim despite the very serious consequences.

A bad outcome after a recognised complication is not enough; the claimant must show the treatment decision fell outside what a responsible body of surgeons would do. Sympathy for the patient does not change the legal test.

Claim failed

Philippa Caroline Deakin-Stephenson v Nebil Behar and Chelsea and Westminster Hospital NHS Foundation Trust

[2024] EWHC 2338 (KB)·2024·Liability decided at trial

Admitted with perforated diverticulitis, the claimant had a laparoscopic washout and deteriorated about 36 hours later, needing an emergency Hartmann's procedure with a stoma and intensive care. She alleged she had asked for a colorectal referral, was improperly moved to private care and was not properly consented, but the judge found none of this proved and dismissed the claims against both the surgeon and the trust.

Consent disputes turn on evidence of what was actually discussed; where the records and the surgeon's account show the alternative procedure was explained, a claim based on inadequate consent is likely to fail.

Browse the whole case library →

Contains information licensed under the Open Justice - Licence v2.0. Judgments from Find Case Law, The National Archives. Summaries are ours; amounts only where printed in the judgment.

§ QUESTIONS

Common questions

Is a perforation during a colonoscopy automatically negligence?

No. Perforation is a recognised risk of the procedure and is on the consent form. Ward v Oxford University Hospitals shows the court asking only whether the perforation should have been seen and dealt with at the time. The claim is usually about the delay in recognising it, not the hole itself.

I signed a consent form that mentioned the risk. Can I still claim?

Yes, if a step was missed. Consenting to a risk does not consent to negligence. In Alexander v HCA International the patient knew pancreatitis was a risk; the claim succeeded because the drug that reduces that risk was never prescribed.

How quickly should a leak or perforation be picked up?

There is no fixed number of hours. The court asks what a competent team would have done with the signs in front of it. In Welsh v Walsall a diagnosis a day after clear warning signs was negligent; in Ward a repair the next morning was not, because nothing had been visible earlier.

Does it matter that it was a private hospital?

The duty is the same. In Alexander the judgment was against the consultant and the claim against the hospital was dismissed; in Healey the hospital settled and recovered 75 per cent from the surgeon. A solicitor will work out who is answerable for what.

What is the preventive drug mentioned in Alexander?

A diclofenac suppository given around the time of an ERCP, which is the standard way of reducing the risk of pancreatitis afterwards. The judge found it was never prescribed or instructed, and that omission carried the whole £550,000 judgment.

How long do I have to claim?

Usually three years from the procedure, or from when you first knew something had gone wrong. For a death, three years from the date of death or of knowledge. Making a complaint to the hospital does not pause that clock.

§ MORE GUIDES

Plain answers to the other questions people ask.

Consent claims →

Informed consent claims since Montgomery: material risks, reasonable alternatives, consent as an ongoing process, and why documented consent defeats claims.

Injured during surgery →

Ten published judgments on injuries caused during surgery: nerves, bile ducts, bowel, perforations and anaesthetics. Four won, six lost. What made the difference.

Deterioration on the ward →

Nine published judgments on patients who deteriorated in hospital: leaks after surgery, sepsis, compartment syndrome and observations not escalated. Six succeeded.

Bowel and bariatric surgery →

Nine published judgments on gastric bypass, sleeve, band, bowel resection, gallbladder and ERCP complications. Four succeeded. Where the line falls.

Private hospital claims →

Eight published judgments against private hospitals and consultants: HCA, Ramsay, Spire, Harley Street and independent clinics. Six succeeded.

NHS payout data →

Official NHS Resolution figures, band by band, for 2024/25.

This guide is general information about the law in England and Wales, not legal advice about your case. ClaimGavel is run by Costart Projects Ltd on behalf of Tomlin & Partners, a specialist medical negligence firm regulated by the SRA. The free assessment on this page is an AI overview to show you roughly where you stand; a solicitor confirms the position in a free, no-obligation conversation.