General Surgeon Fails To Properly Diagnose Perforated Appendix


General Surgery Expert WitnessThis case takes place in Iowa and involves complications following gallbladder surgery. The patient is a female who presented to the ER on with complaints of abdominal pain, which she stated was worse on one side than the other and had persisted for some time. The patient also reported several other gastrointestinal symptoms.  She was sent for a sonogram, which was preliminary read as gallstones with probable inflammation. Later, the patient underwent a laparoscopic cholecystectomy. No gallstones were identified and no filling defect, obstruction or common bile duct dilation was noted. The patient was sent to recovery in stable condition and discharged. The patient returned a few days later with ongoing abdominal pain. A CT scan revealed a perforated appendix with acute appendicitis, as well as a small abscess with fluid. The patient was then admitted for emergency surgery to remove the appendix and prevent further injury.

Question(s) For Expert Witness

  • 1. Do you routinely treat patients similar to the one described in the case? Please explain.
  • 2. Have you ever had a patient develop the outcome described in the case? If so, please explain.
  • 3. Have you ever served as an expert witness on a case similar to the one described above? If so, please explain.
  • 4. Please tell us why you’re qualified to serve as an expert reviewer of this case.

Expert Witness Response E-001161

As a general surgeon, I take care of patients with cholecystitis and appendicitis on a frequent basis.  It’s surprising to me that the clinical team can mistake one diagnosis for another when there are so many preoperative diagnostics to help determine the cause of abdominal pain (LFT’s, CT scan, etc.). I have never had a patient develop this outcome and I have been an expert witness pertaining to a complication from gallbladder surgery.

Expert Witness Response E-006988

This case is very worrisome if the surgeon was led to believe that the ultrasound was positive when it was possibly, in fact, negative. Further, it will be important to discern why the surgeon did not perform surveillance of the abdomen to find the source of the patient’s pain when he found a normal appearing fall bladder. I perform emergency general surgery procedures nearly every week in the course of my busy academic acute care surgery practice — including appendectomy, ileocecectomy, and laparoscopic cholecystectomy. I have previously served as an expert on multiple laparoscopic cases, but not yet for this particular scenario. I have personally found a normal gall bladder in similar previous cases that I have undertaken but have always been fairly aggressive in seeking the source of the patient’s problem when the possibility of a diagnostic error is present – this includes laparoscopic / open exploration and postoperative imaging.

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