General Surgeon Fails To Diagnose Appendicitis In Symptomatic Patient

ByVictoria Negron

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Updated onFebruary 20, 2018

General Surgeon Fails To Diagnose Appendicitis In Symptomatic Patient

This case involves a woman who presented to the hospital after experiencing persistent lower abdominal pain. The emergency physician suspected appendicitis and ordered a CT. The report showed thickening of the appendix and accumulation of fluid in the peritoneal cavity. Although the differential on the CT report included a ruptured appendix, the general surgeon diagnosed the woman with diverticulosis and began antibiotic treatment. While the woman was in the hospital, her appendix ruptured and she developed sepsis, prompting a long recovery. An expert in general surgery was requested to review the records and opine on whether the surgeon missed the diagnosis of a ruptured appendix that sepsis in this patient.

Question(s) For Expert Witness

How often do you treat patients with appendicitis?

What are the clinical and image findings of a ruptured appendix?

Expert Witness Response E-008637

inline imageI see a lot of patients with acute appendicitis in my practice, as I participate in the acute care surgery call schedule at my institution. I operate on an average of 6-8 patients with acute appendicitis per month, with various degrees of severity, from simple to perforated. The clinical findings are generally suggestive of acute abdomen with tenderness to palpation in right lower quadrant, but in late stages, diffusely throughout the abdomen. These should warrant an emergent surgical intervention. CT scan images usually show free intraperitoneal fluid, sometimes small amount of free air or extravasation of contrast. The appendix appears thick with surrounding inflammation. These typical findings are not encountered in all patients and the decision to operate should be made based on the clinical exam in the first place. My thoughts about this case: The information presented is limited, particularly regarding the clinical exam and laboratory values. However, it appears that the CT abdomen was pretty suggestive of appendicitis with rupture, which not being surgically treated, led to progressive worsening and patient demise.

About the author

Victoria Negron

Victoria Negron

Victoria Negron has extensive experience in journalism and thought leadership in the legal space, with a background crafting content, whitepapers, webinars, and current event articles pertaining to the role of expert witnesses in complex litigation matters. She is a skilled professional specializing in B2B product marketing and content marketing. Currently, she serves as an Enterprise Product Marketing Manager at Postman, and previously held the position of Technical Product Marketing Manager at Palantir Technologies, where she developed her skills in launch strategies, go-to-market strategy, and competitive analysis.

Her expertise in content marketing was further refined during her tenure at the Expert Institute, where she progressed from a Marketing Writer to Senior Content Marketing Manager, and eventually to Associate Director of Content & Product Marketing. In these roles, she honed her abilities in digital marketing, SEO, content strategy, and thought leadership.

Educationally, Victoria holds a Master of Business Administration from the University of Florida - Warrington College of Business and a Bachelor of Arts in Literature, Art, and Hispanic Studies from Hamilton College. Her diverse educational background and professional experience have equipped her with a robust skill set in product marketing, content development, and strategic marketing initiatives.

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