This case takes place in Louisiana and involves a male patient who presented to the ER with acute appendicitis. A CT scan showed appendicitis with no leakage or signs of rupture. Following the scan, he waited 11 hours in the waiting room, during which time his appendix ruptured. The patient was then admitted for emergency treatment, where an appendectomy was performed. The rupture of the patient’s appendix caused peritonitis, yet during the appendectomy, the surgeon did not provide a drainage procedure to get rid of the residual abscesses. The surgeon discharged the patient two days after the ruptured appendectomy when the patient was still having abdominal pain, was not passing gas nor having bowel movements, and was complaining about abnormal abdominal pain after the appendectomy, and rejected further testing for the abnormal pain. The patient presented to the ER again shortly after discharge and had to undergo a second surgery for bowel obstruction.
Question(s) For Expert Witness
- 1. How often do you perform appendectomies?
- 2. How soon after diagnosis should a patient undergo surgery?
- 3. What is the standard of care regarding discharge following appendectomy?
Expert Witness Response E-008515
I perform approximately 50 appendectomies/year. Once a diagnosis of acute appendicitis is made, the treatment should be timely (i.e. sooner than 11 hours). A course of observation is only appropriate if diagnosis is unclear or if it is a planned observation of contained perforation/abscess. Most patients with ruptured appendicitis will require iv antibiotics and prolonged hospitalization until resumed diet and normalized fevers/white blood cell count (3-5 days).
Expert Witness Response E-008557
As a general surgeon, appendectomy is one of the most common surgeries that I perform. I have seen all sorts of types of appendicitis (perforated and nonperforated, complicated, appendicitis in pregnant patients). Timing in surgery is still a debatable topic. In short, it depends a lot on the clinic scenario, how sick they are, Operating Room availability and other things. Discharge planning also somewhat depends on the clinical scenario. Sometimes, a patient after this procedure can leave at day two. Sometimes they need to be watched longer. It seems like they were discharged too soon here, but I would need to review the records.