Misdiagnosis of ruptured appendix

In the early hours of the morning, Mr P suddenly developed vomiting, diarrhoea and abdominal pain. By the next day his abdominal pain had worsened and he struggled to sit up in a chair. Mr P was taken via ambulance to A&E.

The doctor recorded 2 examinations. Mr P was found to be dehydrated and had a heart rate exceeding the normal resting rate. Later that day, there were additional signs of tenderness in the abdomen and there was rebound tenderness and Rovsing’s sign (a sign of appendicitis where palpation of the left lower quadrant of the abdomen increases the pain felt in the right lower quadrant) was present.

The working diagnosis in A&E was acute appendicitis. Mr P was referred into the inpatient hospital system under the surgical team. A surgical admission assessment noted that the history was of diarrhoea, then vomiting. The abdominal pain was described as ‘stabbing’ and worse on movement. On examination, Mr P’s abdomen was soft, tender over McBurney’s point (the point that roughly corresponds to the base of the appendix) and guarding (tensing of the abdominal walls) was present. Localised inflammation of the inner wall of the abdomen was found. A diagnosis of either gastroenteritis or appendicitis was given.

Mr P was reviewed by the Registrar. He still had sustained pain and tenderness. The diagnosis of gastroenteritis was made and plans were made to discharge him home.

Following discharge, Mr P’s symptoms worsened which resulted in him being readmitted to hospital. He was tender in the right iliac fossa (part of the abdomen). The treating clinician decided that an emergency appendectomy was required.

A laparoscopic appendectomy (removal of the appendix through several small incisions) and washout was performed. He was found to have a gangrenous appendix, pelvic and inter-loop abscesses and free floating faecoliths. Mr P was admitted to the critical care unit after surgery in a state of sepsis.

According to the records campylobacter (the most common cause of food poisoning in the UK) was discovered in Mr P’s stool sample. A laparotomy for washout and removal of dead tissue was required. Post operatively Mr P remained in critical care for around a week before being transferred to a ward.

A blockage was then discovered in the main artery. Mr P underwent surgery for the removal of this.

It was alleged that the initial ultrasound scan would have been misleading as would the CT scan performed the same day. The CT scan would have shown acute appendicitis and Mr P would have undergone simple laparoscopic appendectomy with one dose of antibiotics and treatment for wound infection. He would have made an uncomplicated recovery and avoided the subsequent Cellulitis, Hallucinations, Respiratory support, laparotomy, blockage of main artery and operation to remove the clot, specialist wound dressing and prolonged hospital stay and recovery.

A settlement was reached with Mr P receiving payment of damages.