Tragic Death of Aspiring Nurse After Rare Condition Misdiagnosed
An 18-year-old aspiring nurse described as a 'beautiful soul' by her family died from a rare intestinal condition just hours after being discharged from hospital, where she was told she was constipated. Zana Afrifa from Smethwick had been struggling with severe abdominal pain, vomiting and constipation for nearly two years before her tragic death on September 18, 2021.
Two Years of Medical Visits
The teenager, who was studying health and social care at college and working part-time at a retirement village, had visited hospital and her GP on six occasions since October 2019. During these visits, her symptoms were repeatedly attributed to constipation. Zana was the youngest of seven siblings and dreamed of becoming a nurse to help others.
On the evening of September 16, 2021, Zana was taken to Sandwell Hospital's A&E department after suddenly experiencing severe abdominal pain accompanied by vomiting and constipation. Her mother reported that Zana was in extreme distress while waiting to be seen, crying out in pain and repeatedly vomiting.
Final Hospital Visit and Discharge
After being examined in the early hours of September 17, Zana was told she was constipated and treated with an enema before being discharged. She was given morphine, an enema and laxatives, which provided temporary relief from pain and allowed her to sleep, according to consultant Dr Prem John who spoke at the subsequent inquest.
However, Zana remained unwell and was found unresponsive in bed by her mother the next morning. A post-mortem examination revealed she had suffered a caecal volvulus – a twisting of the intestine usually seen in older patients – which led to peritonitis, an infection that can prove life-threatening if untreated.
Inquest Findings and Family Concerns
An inquest in October 2023 recorded a conclusion of natural causes. Area Coroner James Bennett said he found 'no evidence of any failures, mistakes or errors in care' by hospital staff, although he noted it would have been appropriate to refer her to the surgical team or carry out an X-ray. The court heard that clinicians decided against further X-rays because the risks outweighed the benefits for a woman of child-bearing age.
Despite the inquest's findings, Zana's family felt opportunities to recognise the seriousness of her condition had been missed. They believed critical blood test results were not reviewed during her final visit to A&E, potentially allowing a serious infection to go undetected.
Medical Negligence Investigation
Lime Solicitors conducted a detailed investigation into Zana's care, obtaining independent expert medical evidence. The medical negligence claim alleged failures in her assessment, investigation and follow-up during her final hospital attendance, including:
- The absence of further imaging
- Failure to escalate to a surgical team
- Inadequate safety-netting advice
Sandwell and West Birmingham Hospitals NHS Trust has not admitted liability, but the claim was settled out of court. Natalizia Capizzi, medical negligence legal director at Lime Solicitors, said: "Zana's case is profoundly heartbreaking. While her symptoms were complex and her condition rare, our investigation identified concerns around her assessment and follow-up during her final hospital attendance."
Family's Heartbreaking Loss
Zana's uncle, Nigel Seales, said: "Zana was a loving daughter, sister and auntie with such a gentle and caring nature. She wanted nothing more than to help others and dreamed of becoming a nurse. Losing her has left a huge hole in our family. While nothing can bring her back, we hope that sharing Zana's story helps raise awareness and prevents other families from experiencing the pain we live with every day."
Dr Mark Anderson, Sandwell and West Birmingham NHS Trust's chief medical officer, said: "We extend our deepest sympathies to all those who knew Zana for their heartbreaking loss. We have reflected on the circumstances of her tragic death and remain committed to learning any lessons that may help improve patient safety."
This tragic case highlights how serious abdominal conditions can sometimes be overlooked when symptoms resemble more common illnesses, and underscores the importance of thorough medical assessment even when initial symptoms appear routine.
