Delayed Diagnosis of Appendicitis Results in Ruptured Appendix


AppendixThis case takes place in Delaware and involves a 13-year-old female with no significant past medical history. She presented to her pediatricians office with complaints of severe abdominal pain and discomfort. She was seen by a Nurse Practitioner who prescribed an adult-strength laxative, prior to ruling out appendicitis. The patient returned home and administered the laxative. Several hours later, the patient’s appendix ruptured and she was taken to the hospital. A life-threatening incident, this condition required immediate surgery to remove the appendix and clean her abdominal cavity. In addition to the immediate and acute danger, she has suffered from a host of complications as a result of the ruptured appendix.

Question(s) For Expert Witness

  • 1. Do you have any specific knowledge on the effects of prescribing an adult-strength laxative to a pediatric patient with acute appendicitis?
  • 2. Is it likely that this prescription aggravated the girl’s condition?
  • 3. Have you ever treated a child with acute appendicitis / or a child who has suffered from a ruptured appendix?

Expert Witness Response E-007322

The laxative should have never been prescribed, and there are a number of reasons why. There are steps that should have been taken to ensure that this patient warranted a laxative – which clearly weren’t taken – and since appendicitis wasn’t ruled out, it was a dangerous decision to prescribe this young woman a laxative. The laxative obviously aggravated the appendix and caused it to rupture far sooner than it would have otherwise.

Expert Witness Response E-009306

As Chief, Division of Pediatric Gastroenterology at a university affiliated hospital, I have not seen an adult-strength laxative administered in a situation such as this. There are more benign medications to prescribe; however, it is not likely that this prescription aggravated the patient’s condition. It may have caused bloating or gas. The issue in this case appears to be a delayed diagnosis which would have prevent the rupture. I have served as an expert witness on a case similar to this.

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