Misdiagnosis of Influenza Leads to a Ruptured Appendix

This case involves a fifteen-year-old female who went to the local emergency room with complaints of abdominal pain. Laboratory studies were ordered and indicated a high white blood cell count. Imaging studies were not ordered and the patient was discharged with a diagnosis of influenza. The patient then went to her family medicine doctor the following day, where once again, a diagnosis of influenza was made. Three days later, the patient visited another doctor who identified a ruptured appendix. The patient was rushed to the hospital where an emergency appendectomy was performed. However, she suffered from numerous complications resulting from the ruptured appendix and may require additional surgeries in the future. Additionally, there was a strong possibility that she was infertile as a result of the delayed surgical intervention.

Question(s) For Expert Witness

1. Should the family medicine doctor have performed specific physical exam maneuvers to rule out the possibility of appendicitis?

Expert Witness Response E-004641

The delay in surgical intervention may very well have affected this patient's outcome. A chief complaint of abdominal pain in a young individual accompanied by an elevated white blood cell count is symptomatic for serious abdominal infections like appendicitis. The diagnosis of appendicitis should become apparent after a routine history and physical examination administered by the physician. This should reveal previous peri-umbilical pain that then migrates to the right lower abdomen (known as McBurney's point). The patient will also typically indicate a lack of appetite as well as nausea and vomiting throughout the day. The patient may also have a fever. Upon palpation, the patient's abdomen will be extremely tender. Appendicitis could also produce a positive psoas and/or obturator sign. Confirmatory diagnosis could have been made using CT scan with contrast. However, all the physical findings found by a physician stated above could warrant immediate removal of the appendix. Failure to remove an inflamed appendix could lead to widespread infection that spreads to other organs and the body cavity (peritonitis) as well as a tubo-ovarian abscess, which can reduce fertility in females.