General Surgery Expert Advises On Emergency Appendectomy That Resulted In Sepsis


General Surgery Expert AppendectomyThis case takes place in Nebraska and involves inadequate surgical and post surgical care rendered by a general surgeon to a pregnant woman who required an emergency appendectomy and later developed sepsis. The 23-week pregnant female patient who presented to the ER with symptoms of appendicitis. An emergent appendectomy was performed and the patient’s appendix was not yet ruptured prior to removal. During the appendectomy, the appendix was ruptured and spilled into her abdominal cavity due to mishandling during surgery. Despite the knowledge of the spillage, the surgeon did not prescribe an antibiotic to the patient upon hospital discharge. In the days and weeks immediately following the surgery, the patient complained of severe back pain and pain originating from the surgical site. She underwent numerous medical examinations to determine the source of pain. One physician diagnosed her with constipation and prescribed her Miralax. Another physician drained a large amount of foul smelling pus from the surgical wound and left the wound open. After nearly 3-weeks of complaints following surgery – and numerous follow up visits with other physicians on staff at the same hospital where the appendectomy had been performed – the patient presented once more to the ER. An emergency C-section was ordered and it was recognized that the patient (and her baby) had developed sepsis (as well as chorioamnionitis). Both mother and baby required significant care and treatment resulting from this poorly managed episode, including intensive post surgical care and neonatal intensive care for the baby.

Question(s) For Expert Witness

  • 1. Do you routinely perform appendectomy surgeries?
  • 2. If so, have you ever ruptured an appendix during surgery?
  • 3. Would this generally require antibiotics to be prescribed, to ensure no infection develops in the patient post op - especially given the fact that this patient was 23-weeks pregnant?
  • 4. Have you ever had a patient develop a similar outcome, post op?

Expert Witness Response E-001161

As a general surgeon working in a major medical institution, I regularly perform operations such as appendectomies. Occasionally, we will also get patients who are pregnant, and the protocols for such patients are very different. In these situations, we have to treat the patient with the intention of giving thorough and decisive care to minimize the risk of complications to the mom and the baby. I have performed appendectomies on both ruptured and non-ruptured appendices. The potential for infection in a rupture appendix is much higher, and treatment is often prolonged to mitigate the risk of complications as experienced by this patient. However, treatment must oftentimes be tailored to the medical conditions at hand. It is generally accepted that patients with ruptured appendicitis get prolonged antibiotics, but the type and duration can sometimes depend on the patient’s response to the treatment. The prudent physician needs to watch this response closely to make sure that the treatment is appropriate. I have never had a patient develop a similar outcome, and I have served as an expert witness in cases involving intra-abdominal infections. However, I’ve never been an expert witness for a pregnant patient with appendicitis. That being said, I performed an operation on a pregnant patient less than 3 weeks ago.

Expert Witness Response E-008558

I do routinely perform appendectomies and I do have experience with appendix “fracture”. Appendectomy is one of the most common procedures that I perform. I have performed more than 100/year for the last 5 years. In this case, I would have given the patient a course of antibiotics and I would have left a drain. I would definitely consult with OB-GYN and prescribe appropriate abx. I have never had a patient develop a similar outcome.

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