A five-year-old girl from Hull tragically died on her way to see an out-of-hours General Practitioner just hours after another doctor sent her home with a ‘tummy bug’.
Esma Guzel’s family were told to seek further help if her condition deteriorated, but sadly, died in the early hours of May 10, 2019, following a cardiac arrest. It was later discovered she had an uncommon health condition that was not detected prior to her death.
A full day of evidence was heard at Hull Coroners’ Court on Monday at the inquest into her heartbreaking death.
It was heard from independent expertise in court that the cardiac arrest was a result of her pre-existing undetected condition, Congenital Diaphragmatic Hernia (CDH) and part of her bowel becoming stuck in the hole in her diaphragm.
The condition could not be identified in pre-natal ultrasounds and was also not diagnosed when Esma was seen by her GP the evening before she died.
Esma’s mum previously spoke to Hull Live in the immediate months after Esma’s tragic death to help raise awareness of CDH.
At the time, she said that the “spark of life she made has gone” and Esma loved swimming and gymnastics. She said of the immediate signs when Esma fell unwell: “She came home from school and was normal, went to my mum’s for her tea and just said, ‘Nanna, I feel sick’ and she was sick at my mum’s house.
The family made an appointment to see a GP on the evening of May 9, where an assessment made of Esma concluded the cause was likely a tummy bug, but advice was given to contact NHS 111 if the ill-health continued.
Esma’s mum then called 111 at 1.38 am on May 10 and was advised to take her to an out-of-hours GP service in Beverley. Tragically, by the time Esma and her dad reached there, she had died. A doctor carried out CPR and Esma was taken to Hull Royal Infirmary, but it was too late.
The bulk of Monday’s proceedings at Hull Coroners’ Court was taken up by the testimonies and questions for two independent experts.
David Crabbe, a consultant paediatric surgeon, explained that CDH is a condition which affects approximately 1 in 2,500 births and usually can be detected in ultrasound scans. Esma had a Bochdalek CDH, consistent with a late presenting condition and radiology evidence indicated that it was simply not possible to have identified it on the three pre-natal scans.
If ever diagnosed, Esma would have been prepared for surgery and the outlook for late presenting CDH after surgery is excellent. The hole in the diaphragm was small, which led to the incarceration of the illeum part of the bowel in the hernia before she died, consistent with the symptoms Esma was reported as having, namely abdominal pain and vomiting. The progressive intertestinal obstruction and hypovolemic shock, fluid loss in the body, led to the fatal cardiac arrest.
Mr Crabbe made clear that the GP’s assessment of May 9 could not have foreseen the cardiac arrest and he could not identify a specific trigger for the bowel’s sudden incarceration. He also stated that had Esma’s cardiac arrest occurred in hospital, it was likely on the balance of probabilities that she would have survived.
The highest level response that the 111 call at 1.38am could have prompted was a Category 3 dispatch of an ambulance within an average 120 minutes, but Esma died shortly after 2.20am.