This case takes place in Ohio and involves a female patient who presented to her primary care physician with abdominal pain. The doctor referred her to the emergency room, and called the ER to let the hospital know that the patient would be arriving with suspected appendicitis. The patient was examined by the treating physician in the emergency room upon her arrival. The physician noted that the patient was in severe distress with abdominal pain of an unknown context. A CT Scan was performed and interpreted by another physician. The physician reported that the appendix was not visualized, but that there appeared to be a foreign body in the intestines. The patient was prescribed medication for her pain and discharged. The patient’s pain and fever continued, and she reported to a different emergency room some time later. Another group of doctors examined the same CT report and noted there was not a foreign body in the patient’s intestines, but that she was in fact suffering from gangrenous appendicitis.
Question(s) For Expert Witness
- 1. Do you diagnose and treat appendicitis? If so, how often?
- 2. What is the standard work up for a patient presenting to the emergency with these symptoms?
- 3. Should the patient have been discharged without assessment of his appendix on the initial ER visit?
Expert Witness Response E-005045
I diagnose and treat appendicitis commonly. This is one of the most common surgical problems presenting to the Emergency Department. It is a clinical diagnosis that can require a high level of suspicion. Typical workup includes history and physical exam. Lab work can be helpful, and if indicated, a CT scan and/or surgical consultation in the ED. It is difficult from the information presented to determine if the patient should have had further workup and/or surgical consultation on the first ED visit. Typically, one does want to actually visualize the appendix on the CT, and the findings appear to be atypical on the first visit.
Expert Witness Response E-001278
I have been evaluating and treating appendicitis for the last 34 years. It is hard to say how often, but I would estimate that I have done this thousands of times during my career. The most important part of the workup is the physical exam and the WBC and CT scan. If the physical exam is definitive enough then the patient should receive an immediate surgical consultation in the ED without waiting for lab work to come back and be taken to the OR based on the surgeon’s evaluation. The patient described in your case overview should definitely not have been discharged without assessment of her appendix during the initial ER visit.