A little girl who died as her parents drove her to the doctors with a "tummy bug" was suffering with an undetected condition, an inquest has heard.
Esma Guzel, five, had come home from school feeling sick, just hours before she was rushed to see out of hours medics on May 10, 2019.
The schoolgirl from Hull, East Yorkshire, died of a cardiac arrest as a result of her pre-existing undetected condition, Congenital Diaphragmatic Hernia (CDH), where part of her bowel was becoming stuck in the hole in her diaphragm, Hull Coroners Court heard.
Her mum, Kerry, claims they had been to see their GP the night before on May 9 and were told it was a "tummy bug", with advice to come back if Esma's symptoms got worse.
When Esma's condition deteriorated in the night, her parents rushed her to the out of hours GP at Hull Royal Infirmary, but by the time they got there is was too late, HullDailyMail reports.
Speaking at the time of her daughter's death, Kerry said that the "spark of life she made has gone".
She said: "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.
“Later on, her sick went a brown colour and we kept her in bed and kept giving her fluids. She was exhausted.
“The next day she slept and we took her to the doctor and she checked her and said she thought she had a sickness bug.”
As Esma continued to be poorly into the evening of May 9, her parents called 111 and were advised to take her to the out of hours doctors.
By the time they arrived, doctors carried out CPR on Esma but it was too late to save her, and only tests could reveal that she had CDH.
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.
The inquest into her death opened this week on Monday, March 21.
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 added that had Esma's cardiac arrest happened in hospital, it was likely on the balance of probabilities that she would have survived.
Dr Lynette Hykin provided an independent assessment of the GP's interaction with Esma on May 9.
Esma's mum and the GP had different recollections as to Esma's body position when examined abdominally, with the GP recalling examining her flat on her back before she curled up onto her side.
Dr Hykin said there were no GP assessment features that dictated hospital referral.
She expressed potential concerns of care falling below the standard of a reasonably competent GP with regard to assessment of the abdominal pain Esma suffered and the colour of the vomit, which worsened by the time of the 111 overnight call to dark brown from light.
However, those concerns about the GP assessment fell away if the GP's recollections of it were found to be correct.
Assistant coroner Dr Dominic Bell expressed his gratitude to the Esma's parents, in court throughout the day's proceedings: "Once again, I thank you for your dignified conduct." He indicated that the inquest would resume on Wednesday afternoon with a conclusion expected.
"We are only moving towards the conclusion of the first part," he added, in a reference to separate Section 28 regulation proceedings concerning a report to prevent future deaths, set to take place in April.
CDH UK is a charity dedicated to raising awareness of and supporting those affected by Congenital Diaphragmatic Hernia. To find out more about the condition, visit their website here.
