The post-mortem examination of Frances Sheridan by the State Pathologist is unequivocal in its conclusion. Dr Marie Cassidy states that the nine-year old died "from complications of recent surgery".
Frances Sheridan had her appendix removed three weeks prior to her death. This followed a diagnosis of acute appendicitis by doctors at Cavan General Hospital. The appendix is a blind pouch situated in the lower abdomen on the right side. At its opening into the gut it is very narrow and is easily blocked. This leads to an initial inflammation of the appendix (appendicitis). Pressure builds up within, bacterial infection sets in, the appendix swells up and it eventually becomes gangrenous as its blood supply is cut off. If left untreated, it then perforates, leading to peritonitis - the spreading of pus and infection throughout the abdomen and pelvis.
The death rate from acute appendicitis is less than 0.3 per cent, rising to 1.7 per cent following perforation.
Dr Cassidy's report does not mention any sequalae of perforation, so it is reasonable to assume that young Frances Sheridan was operated on while her appendix was still inflamed.
Scar tissue, which is part of the normal healing process, often forms what are called adhesions. These fibrous bands usually cause no ill effects; however, in some cases they attach to or surround other organs in the abdomen, giving rise to varying symptoms.
In extreme cases, the adhesions surround the bowel in a sling-like fashion. As long as the diameter of the sling remains wide, the bowel is free to slide in and out and move in a normal way. However, if this aperture is narrowed, the bowel becomes trapped. Eventually, its blood supply is squeezed and the contents of the bowel cannot move on. This is termed intestinal obstruction and represents an acute abdominal emergency - requiring further surgery.
The symptoms of internal obstruction include pain, vomiting and abdominal distension. More recent food intake cannot travel through the system and the risk of regurgitation of intestinal contents rises.
Children and older people are especially prone to inhaling vomit, which is irritant to the airways. Such an event may cause a cardiac or respiratory arrest, leading to sudden death.