Medical Malpractice – Failure to diagnose appendicitis

Case Name: Warren v. Doe Medical Group

Disposition: $200,000 Settlement

Allegations: Failure to diagnose and treat appendicitis and postoperative infection

Facts: On 12/27, Mr. Warren, then aged 34, presented to Doe Medical Group complaining of acute onset abdominal pain in his right upper quadrant. He was examined by Dr. Roe, who palpitated and auscultated his abdomen. She documented his extreme tenderness to mild palpitation and noted diminished bowel sounds. Based on this physical exam only, a diagnosis of cholelithiasis (kidney stones) was made, and Mr. Warren was sent home on painkillers. No lab work was ordered. No emergent nor urgent imaging studies was ordered. No surgical consult was ordered. He was sent home with medication for pain.

The next day, 12/28, Mr. Warren presented to the Emergency Room 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. Mr. Warren was taken into surgery and the appendicitis was confirmed. It was noted by the surgeon that the tip of the appendix was gangrenous. The pathologist examining the removed organ noted that the appendix had microperforated. Both of these findings confirmed that Mr. Warren had been suffering from appendicitis during his presentation at the Urgent Care on December 27th.

Mr. Warren remained in the facility for approximately 24 hours. The surgeon wrote orders for antibiotics to be administered postoperatively, but there is ambiguity as to whether they were given. Mr. Warren’s appendix was gangrenous and perforated, and clearly antibiotic therapy was crucial to his survival and recovery in this situation. Nevertheless, he did not receive any posoperative antibiotics and was discharged home on painkillers only in the late morning of 12/30. By that afternoon Mr. Warren’s pain was increasing. He presented to the Emergency Department 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 and recovering from all that had happened, Mr. Warren 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 where on the endoscopy the surgeons found a large placenta-like clot in his stomach. It was concluded that this was the result of hemorrhage from trauma caused by his nasogastric tube suction being up 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.

Mr. Warren was discharge on 1/28. He was admitted again on 2/11, for continuing abscesses.

Injuries/Damages: In addition to his pain and suffering, Mr. Warren 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.

Contentions: All of the injuries to Mr. Warren 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.

Special Notes: The same doctor who missed the diagnosis of Mr. Warren’s appendicitis at the Urgent Care also failed to correctly diagnose colon/rectal cancer in another patient.  See the Shilling medical malpractice case.