Missed or Misdiagnosed Appendicitis
Appendicitis, while common, is a serious abdominal condition that requires immediate medical attention and often times surgery. It affects hundreds of thousands of people per year and while not many deaths are attributed appendicitis, if left untreated, the appendix could burst causing an infection that could later prove to be fatal.
Misdiagnosis/Missed Diagnosis of Appendicitis
The misdiagnosis of appendicitis is one of the most common malpractice suits against physicians because symptoms are common and often mimic other types of illnesses. Through a series of diagnostic procedures, your doctor should be able to distinguish appendicitis from other common ailments that have almost identical symptoms such as Crohnâ€™s disease or cecal diverticulitis. Since the appendix practically serves no function, it is typically surgically removed if there is the slightest indication of inflammation. Diagnosing appendicitis in a timely manner is critical. An untreated inflamed appendix could burst and release harmful bacteria into the bloodstream causing further complications, and even death. A burst appendix also leads to surgical complications.
With over 250,000 cases of appendicitis reported in the United States annually, less than 50 percent of those cases show classic symptoms: mild to severe pain the in the lower rights area of the stomach, fever, and nausea. Since symptoms are common to other ailments, the doctor should perform a differential diagnosis to prevent a missed diagnosis, or failing to detect the medical condition altogether. A differential diagnosis involves making a list of the signs and symptoms the patient is experiencing, as well as medical history, and conducting a series of tests to better match the symptom with the illness. Patients experiencing symptoms that correspond with appendicitis are often times observed for an amount of time to see if the problem will resolve itself on its own or result in another condition.
What is Appendicitis?
Appendicitis an inflammation of the appendix typically caused by some sort of blockage in the appendix itself. This blockage decreases blood flow and increases pressure in the appendix, all while bacteria from the obstruction begin to fester. A calcified stone made of fecal matter is the most common cause, but tumors, parasites, and gallstones could also cause the obstruction. Appendicitis can happen to anyone, but it most commonly occurs in males ages 10-30.
Signs and Symptoms â€“ What Your Doctor Should Look For
When diagnosing appendicitis, doctors should be aware and actively looking for the â€œclassicâ€ signs and symptoms which include:
- Severe abdominal pain on the right side
Since symptoms are common to other medical conditions, your doctor should be on the lookout for less common symptoms to be able to come to a definitive conclusion.
- Loss of appetite
- Abdominal swelling
- Trouble passing gas
Diagnosing Appendicitis â€“ Did Your Doctor Run The Correct Tests?
Since symptoms of appendicitis can indicate other illnesses in the body, there is no one specific test for diagnosing this condition and appendicitis can often be mistaken as something else. One example is diverticulitis, a condition in which the colon is inflamed and causes pain on the right side of the abdomen where the appendix is located. Irritable Bowel Syndrome shares a lot of the same symptoms of appendicitis like diarrhea, lower abdominal pain, and constipation. Other medical conditions that can be confused with appendicitis are gall bladder and inflammatory liver diseases, duodenal ulcers, Celiacâ€™s disease, and Crohnâ€™s disease. For female patients, pelvic inflammatory disease and ectopic pregnancy should be ruled out before an appendicitis diagnosis.
One of the first tests your doctor should perform is the Complete Blood Count test to determine your white blood cell count and test for a bacterial infection. Those with elevated levels white blood cells account for 80 percent of appendicitis diagnoses. Other tests done to diagnose appendicitis are:
- Physical examination on the abdominals to detect inflammation
- Urine Tests (urinalysis â€“ to rule out a kidney infection or urinary tract infection)
- Imaging tests (X-ray, CT scan, or abdominal ultrasound)
No test will diagnose appendicitis with certainty but different diagnostic procedures will be able to rule out other conditions to set you on the right course for treatment.
Treatment â€“ Did Your Doctor Explain Your Options?
In most cases of appendicitis, surgery is required as doctors feel it is best to remove the appendix in its entirety at the first sign of infection and inflammation. Appendicitis can also be treated with antibiotics, but surgery is most effective.
- The only curative treatment of appendicitis, an appendectomy is the surgical removal of the appendix and can be done by doing one long abdominal incision (Laparotomy), or through a series of smaller incisions to remove tissue. (Laparoscopic surgery)
- Before every appendectomy, antibiotics should be administered to work against the bacteria that is already growing. In cases where the appendix has already burst, the doctor will administer antibiotics through an IV. In most cases antibiotics will be administered for several days and after the infection has cleared up, the patient will undergo an appendectomy.
- The following is a list of common antibiotics:
- Piperacillin and tazobactam sodium (Zosyn)
- Ampicillin and sulbactam (Unasyn)
- Ticarcillin and clavulanate (Timentin)
- Cefepime (Maxipime)
- Gentamicin (Gentacidin and Garamycin)
- Meropenem (Merrem)
- Ertapenem (Invanz)
- Metronidazole (Flagyl)
- Clindamycin (Cleocin)
- Levofloxacin (Levaquin)
Even though the appendectomy is still the most common treatment, scientists and researchers have found some evidence that appendectomies are not always necessary if the case of appendicitis is not complicated. However, if the early treatments fail, then ultimately an appendectomy will ensue.
With over 50 percent of patients experiencing atypical symptoms and 30 percent of appendices ruptured at the time of surgery, it is common for appendicitis to be missed. Medical records will most likely include a classic symptom or finding that was over looked. This results in administering incorrect tests or being given treatment that does more harm than good. Lab tests completed at different medical facilities may be mishandled or misinterpreted when relaying information back to the doctor.
Answer the following questions to determine if you are a victim of misdiagnosis/missed diagnosis of appendicitis
- What did your doctor do after you explained your symptoms?
- What tests were administered? Did your doctor explain why that test was done?
- Was your medical history taken?
- Did the doctor use â€œdifferential diagnosisâ€ to rule out other common diseases?
- How do you know your tests results are accurate?
- Were lab test results sent to another facility?
- Where was that facility located?
- How do you know if the information was relayed back correctly?