FAILURE TO Dx APPENDICITIS

Case involves the failure to diagnose and treat an appendicitis resulting in acute gangrenous appendicitis with perforation, an abscess and sepsis. The potential defendants are ER and Family Practice physicians. On June 5, presented to the Mercy Hospital emergency room with complaints of sudden and acute severe abdominal pain just below his belly button. According to the hospital record, the mid-abdominal pain was described as sharp, cramping, and constant. He also complained of loss of appetite, nausea and vomiting. Pain scale 8-9. BP: 124/84, temperature: 98.3, pulse: 78 and respiration: 18. According to plaintiff, he vomited in the waiting room and the pain was so severe he almost passed out. The ER physician, did not order any blood work or imaging studies. Moreover, he did not conduct a physical examination of the abdomen. Defendant prescribed phenergan, toradol and promethazine. After 1 hour and 10 minutes, patient was discharged with a diagnosis of gastroenteritis. On June 7, patient presented to his family physician with complaints of stomach pain and a low grade fever, but defendant failed to order blood work or any diagnostic studies – telling plaintifft to “keep an eye on it,” and sent him home.

Within eight days of the office visits, he presented to Good Samaritan hospital and was diagnosed with an acute gangrenous appendicitis with perforation, right lower quadrant abdominal abscess and sepsis. He suffered an extended hospitalization, and residual complications.

Had the ER and FP doctors properly obtained blood work and imaging studies, would an appendicitis been evident, and would surgery have been implemented (versus the initial presentation and finding 9 days later)? Also, had surgery been implemented on the first ER visit, would plaintiff have suffered the perforation, abdominal abscess and sepsis?

EXPERT RESPONSES

Yes it sounds like someone dropped the ball. Certainly on his day of presentation and someone should have follow up with him before 9 days…. for an ER doctor and FP appendicitis this is routine stuff.

– Dr PVG

I believe that if a proper history and physical, as well as appropriate lab and x-rays test had been conducted on the initial visit to the ER that the diagnosis would have been made at that time. The complications, more likely than not, would have been avoided. Failure to perform these basic maneuvers was a deviation from the standard of care. – Dr DD

Negligence prevented a simple laparoscopic appendectomy

– Dr JSF

Sounds like a delay in diagnosis with the ensuing complications totally avoidable

– Dr JK