General Surgery Expert Witness Opines on Failure to Notice Acute Appendicitis

A fourteen-year-old male visited an emergency room with his mother, complaining of stomach pains, nausea, headache, and no extreme medical history. He was seen by an emergency medicine physician an hour later. During the one-hour duration, the patient said his pain had been consistent, and on the pain scale of 1-10, it was a 7. The physician noticed swelling in the abdominal region and the patient received a blood test. The fourteen-year-old had a slightly elevated white blood cell count and the mother said the child had been vomiting earlier and was suffering from the flu. The high percentage of leukocytes circulating in the blood could have been from a variety of symptoms, as it is quite common in patients fighting off previous infections. The emergency medicine physician released the patient, and ordered him to see his primary care physician in a week if the condition did not lessen. However, the patient did not make it that long, as the following day he was rushed to the emergency room with extreme stomach pain. The patient had suffered from acute appendicitis, and passed away due to his appendix bursting, which led to sepsis. Sepsis is a potentially fatal systemic inflammatory response caused by a severe infection and it was confirmed that the bacteria from the appendix caused the immune response.

Question(s) For Expert Witness

1. Should the emergency medicine physician have noticed the symptoms of appendicitis?

Expert Witness Response

In my opinion, it was nearly clear that the patient was suffering from a form of acute appendicitis. His stomach pain and swelling are classic symptoms of appendicitis, different from flu-like symptoms. While he was possibly suffering from another illness, it could have been related to the infection running through his body. The physician should have pursued further tests, such as pushing down on the abdomen and to test the patient's pain levels, or an MRI, which are known to diagnose appendicitis the best in children. The MRI would have revealed the inflammation and a blockage in the appendiceal lumen, which would have confirmed the symptoms. If this diagnosis occurred, the patient's life could have been saved. This was a vital mistake of misdiagnosing the patient, leading to the patient’s passing.