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Failure to Diagnose Appendicitis

$200,000 – Medical Malpractice/Negligence

Facts

An urgent care did no testing when a patient presented with signs and symptoms of appendicitis. Eventually surgeons found a gangrenous and perforated appendix.

On 12/27, a 34-year-old presented to Doe Medical Group complaining of acute onset abdominal pain in his right upper quadrant. He was examined by Dr. Roe by palpating his abdomen. She documented his extreme tenderness to mild palpitation and diminished bowel sounds. Based on this physical exam only, a diagnosis of cholelithiasis (kidney stones) was made, and the patient was sent home on painkillers. No lab work was ordered. No emergent or urgent imaging studies was ordered. No surgical consult was ordered. The patient was sent home with pain medication.

The next day, 12/28, the patient went to the ER of Doe Medical Group with fever and increased abdominal pain. He was worked up by the ER staff and a provisional diagnosis of acute appendicitis was made. His white blood cell count was elevated at 13.3. Surgical consult was obtained and preparations were made for an emergent laparoscopic appendectomy. The patient was taken into surgery and the appendicitis was confirmed. The tip of the appendix was gangrenous, and a pathologist found microperforations. Both of these findings confirmed that the patient had been suffering from appendicitis during his presentation at the Urgent Care on December 27th.

The patient remained in the facility for approximately 24 hours. The surgeon wrote orders for antibiotics but it is unclear whether they were given. The patient was eventually discharged home on painkillers only. By that afternoon the patient’s pain was increasing. He went to the Emergency Department on 12/30 complaining of a fever of 102 degrees and pain at his incision site. The ER staff noted that his only medication was a painkiller. He was sent home and told to follow up at the surgical clinic in two days.

On 12/31, Mr. Warren again presented to the Emergency Department with escalating symptoms. He was now vomiting, was clammy and cool to the touch, and had a distended abdomen. He was admitted with a provisional diagnosis of postoperative ileus. Subsequent CT scan revealed that he actually was suffering from a postoperative abscess, i.e., a postoperative infection. A CT scan-guided drainage was performed and a quantity of feculent bloody fluid was aspirated from his abdomen.

While still in the hospital, the patient began bleeding in his gastrointestinal tract. Quantities of bright red blood were observed in his nasogastric tube, and he was found to be losing blood rectally. Transfusions were done. He was taken to the operating room again. The surgeon found a large, placenta-like clot in his stomach. They concluded it was the result of hemorrhage from trauma caused by his nasogastric suction tube rubbing against the wall of the stomach and going unnoticed for too long a period of time. He eventually received several units of blood to treat this hemorrhage.

The patient was discharged on 1/28. He was re-admitted on 2/11 for continuing abscesses.

Allegations/Contentions

All of the injuries to the patient could have been avoided had he been adequately examined and treated when he first presented in the Urgent Care on 12/27. At a minimum, the physician should have ordered a CBC and UA (urinalysis). These tests would have revealed the fulminating appendicitis in time to avoid the development of gangrene and perforation. The delay in treatment led to the rupture of the appendix and the seepage of feculent material into his abdominal cavity.

Injuries/Damages

In addition to his pain and suffering, the plaintiff is now left with an abdomen full of scar tissue as a result of the significant infection and several surgical procedures that were required to deal with the infection.

Special Notes

The same doctor who missed the diagnosis of plaintiff’s appendicitis at the Urgent Care also failed to correctly diagnose colon/rectal cancer in another patient.


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