Childhood Appendectomy Causes Severe Third Spacing of Fluid and Shock

This case involves the care of a 10-month-old infant who was admitted to the hospital for lethargy and a distended abdomen. The working diagnosis after interpretation of imaging studies was thought to be acute appendicitis. The child was taken in for emergent surgery and the procedure was conducted without complication but the surgical report indicated that the appendix was ambiguous for actual inflammation. Several complications arose while the patient was in the intensive care unit; the patient experienced severe third spacing of fluid and went into hypovolemic shock. It was suspected that the child had a postoperative infection.

Question(s) For Expert Witness

1. What are some of the signs that indicate mismanaged care post-operatively?

Expert Witness Response E-000159

From the case summary that you shared with me, it seems as if the patient may have been mismanaged postoperatively given that the surgery went without complication. But what is most troubling to me is the third spacing of fluids. This may be an ominous sign of a surgery that went longer than expected or one that was not properly replaced with IV fluids. Cases like this need close monitoring of the patients fluid status throughout the procedure and afterwards in a critical care setting. If the patient did have an insidious infection this would complicate the problem even further. I would have to review more detailed information in order to provide an assertive opinion.