Delayed Diagnosis of Gangrenous Appendix Leads to Life-Threatening Infection

This case involved a patient who complained of severe epigastric pain that was not well characterized. The pain waxed and waned over the course of the past few days but became progressively worse before arriving at the hospital. The patient’s working diagnosis in the ER was Gastritis and the doctors began treatment with Maalox, Oral Lidocaine, Pantoprazole, Hydromorphone, and Ondansetron. The patient was deemed stable and discharged the same night with instructions to avoid stomach irritants such as alcohol, caffeine, or spicy food.

The patient returned to the hospital that same day with increased pain and further CT workup showed a dilated appendix to approximately 12mm at which point the patient was taken for an emergent laparoscopic appendectomy. Medical records indicate that at the time of removal the appendix was nearly gangrenous and burst upon being grasped. The patient suffered post-operative infection/abscess due to the rupture and spillage of infected fecal tissue into the abdominal cavity.

Question(s) For Expert Witness

1. What is the standard operating procedure for ruling out emergent cases such a severe abdominal pain and a possible ruptured appendix?

Expert Witness Response E-000365

It is believed that it was a departure from the standard of care for the physicians inability to recognize an acute appendicitis and the subsequent discharge of the patient without further clinical workup resulted in debilitating complications.