Appendicitis Misdiagnosis

The purpose of this page is to explain appendicitis medical mistake cases and give you some idea of the settlement and trial value of these often tragic claims.

Appendicitis is an inflammation of the inner lining of the appendix. The primary causes include infection of the appendix and obstruction of the appendiceal lumen. Appendectomy (removal of the appendix) is the currently the only cure for appendicitis.

The median age of appendectomies is 22 years, meaning that half of all appendectomies occur under the age 22 and the other half occur over the age 22. Appendectomies carry a 4-15% risk of complications.

Some of this risk with these procedures clearly cannot be avoided. But some of the risk and some of the serious complications from failing to diagnose and treat appendicitis is often caused by health care errors. If you believe you have been injured by medical malpractice, we will be glad to talk to you about what happened to you and figure out whether our attorneys think you may have a claim worth pursuing. Call 800-553-8082 or get a free online consultation.

Appendicitis Diagnosisappendicitismalpractice

Diagnosis of an appendicitis can be a challenge. Why? Symptoms mimic several other abdominal conditions. So health care providers often get it wrong. There is also no single accurate diagnostic test for appendicitis. So doctors have to both spot the possibly of the condition and then work to exclude other possible causes.

Classic symptoms of anorexia, pain around the belly button, nausea, lower right quadrant pain, and vomiting occur in only 50% of cases. Further complicating diagnosis, are statistics showing that only 5% of cases involving abdominal pain are actually appendicitis.

Perforation is a primary complication associated with appendicitis. The incidence varies between 16 and 40 %. A higher prevalence is seen in younger age groups (40-57%) as well as older patients (50+), where the incidence ranges between 40-57%. The increased incidence in the younger and older age group is primarily due to delayed diagnosis or misdiagnosis.

Failure to Diagnose Cases

Failure to diagnose appendicitis most often occurs due in cases involving

  • atypical presentation of symptoms,
  • failure to receive proper physical examination including rectal examination,
  • receipt of analgesia for undiagnosed abdominal pain or symptoms,
  • misdiagnosis as gastroenteritis, and
  • inadequate follow-up within 12 to 24 hours.

Often appendicitis is missed and the doctors catch it quickly. These cases usually have good outcomes. But left untreated, severe complications can occur which include perforation, sepsis, or death.

Misdiagnosis of abdominal pain for appendicitis is very common in children presenting with abdominal pain, and it is estimated to occur at a rate of 28-57% in children under the age of 2-12 years. In infants, misdiagnosis for appendicitis is nearly 100%. Annual incidence rates are 25 per 10,000 (age 10-17 years), 1-2 per 10,000 (children four years and under), and 1.1 per 1000 over all age groups. 250,000 cases of appendicitis are reported in the U.S. annually. Individual risk rates are approximately 6-9% for development during a lifetime, being slightly higher in men than women. It has been reported that men have a higher rate of mortality compared to women (1.9% vs. 0.7%).

In a scientific review published earlier this year in American Journal of Surgery, authors reviewed patient data from 1998 to 2007 in the U.S. and found that the rate of negative appendectomies has been declining over the years. After reviewing 475,651 cases of appendectomies, it was found that 56,252 were negative appendectomies, representing a misdiagnosis rate of 11.8%. In 1997 it was discovered that the rate was 14.7% which declined to 8.5% in 2007. Negative appendectomies are appendectomies where, after removal of the appendix, it is found that the patient did not have appendicitis. The study also found that of the negative appendectomies, 71.6% were in women compared to 28.4% in men.

It is believed that the higher negative appendectomy rate seen in women is possibly due to misdiagnosis of gynecological conditions. In women over the age of 45, malignant disease of the ovary is the most common gynecological condition misdiagnosed as appendicitis. In younger women it was found that ovarian cyst was most commonly diagnosed as appendicitis. In contrast, diverticulitis of the colon is the most commonly misdiagnosed condition in men.

It has been suggested that shorter stays in emergency departments, fewer physical findings, lab tests, and diagnostic imaging may lead to misdiagnosis as appendicitis. Though diagnostic imaging such as CT has become more common in evaluating patients presenting with possible appendicitis, a study has demonstrated that diagnosis with CT (computed tomography) may only apply to certain people. Researchers have reported that CT imaging and other advances in medical technology have lead to a decrease in negative appendectomies in women under the age of 45 years. However, there was no correlation between CT imaging and rates of appendectomies in women over the age of 45 or men.

Misdiagnosis, leading to negative appendectomies, presents an undue risk of complications and costs to both the patient and health care system. Though misdiagnosis has been shown to be thankfully declining in the U.S., it is still quite prevalent, and there does not seem to be any single diagnostic test that may lead to the elimination of the negative appendectomies.

Sample Verdicts in Appendicitis Cases

Below is a list of verdicts and settlements in appendicitis cases. There have not been any reported cases in Maryland that have gone to a verdict that we found. The purpose of this is to give you some idea of the value of these cases. But a word of caution: we have excluded defense verdicts, and it is extremely hard to compare cases based on a short fact summary. In the real world, there are so many factors that make up the value of a malpractice case. Still, we think these results are instructive for malpractice victims:

  • 2015, New York: $450,000 Verdict. A 16-year-old female under the care of the defendant nurse shows signs and symptoms of appendicitis. The defendant nurse fails to perform an adequate physical exam and failed to order the appropriate test. The 16-year-old female then suffered a ruptured appendix that required surgery. The defendant was also held liable under the doctrine of res ipsa loquitur, and the jurors returned a verdict finding the defendant did not depart from good and accepted medical practices in arriving at a diagnosis of constipation for A.C. They found the defendant was negligent in failing to order an ultrasound or CT scan to rule in or out an appendicitis. The jury awarded $450,000 for future pain and suffering for a period of 30 years. 
  • 2015, California: $10,000 Settlement. A 9-year-old boy arrives at Riverside Community Hospital with signs and symptoms of appendicitis and is treated by the staff. The plaintiff contends staff of Riverside collectively failed to diagnose timely and treat his appendicitis, which resulted in previously unnecessary surgeries and failed to provide the applicable standard of care. The defendant agreed to settle the matter for a gross amount of $10,000.  This is an odd settlement.  There has to be a backstory. 
  • March 2013, Oregon: $325,000 Settlement: A 16 year-old girl arrives at the emergency room complaining of severe abdominal pain and discomfort. Shortly after being admitted, she is diagnosed and discharged with a urinary tract infection. Same problem we talked about above, right? But the doctor has to do more to flush out what this young girl has. The diagnosis is made not only without an x-ray, but without the emergency room physician consulting a general surgeon. Less than 12 hours from her original emergency room visit, the teenager suffers a ruptured appendix, resulting in an infection of the abdomen. Consequently, the plaintiff becomes septic. She remains in the hospital for 20 days after the rupture. The plaintiff sues the emergency room physician for medical malpractice, claiming the physician 's mistake was failure to diagnose the appendicitis. The parties agree to settle before trial for the amount of $325,000.
  • January 2013, New York: $450,000 Verdict: The plaintiff, 16, arrives at St. Barnabas Hospital in the Bronx suffering from abdominal pain. An emergency room physician performs an x-ray, physical examination and a blood test. After reviewing the results, she chooses to diagnose the boy with constipation, prescribing him with an enema and laxatives. She advises him that should he continue to feel discomfort, he should visit his primary doctor. Six days later, the boy is continuing to feel abdominal pain and chooses to visit his primary care doctor for an additional examination. The doctor conducts tests similar to those conducted by the emergency room physician but also orders a CT scan. A blood test shows the plaintiff’s blood test results indicate a high white blood cell count, indicating infection. The boy is directed to return to the hospital where he is diagnosed with a ruptured appendix and sepsis. The plaintiff’s mother, acting on his behalf, sued the emergency room physician for medical malpractice, claiming the defendant failed to diagnose her son with appendicitis. Plaintiff’s counsel asserts that the defendant should have acknowledged the reports of severe abdominal pain during the initial examination and failed to recognize the blood test’s results. They also argued that the defendant should have performed a CT scan, which would have revealed appendicitis. The ER doctor argues that she did not deviate from the standard of care and that she properly diagnosed and treated the plaintiff. She argued that the plaintiff’s complaints were reported in the upper-left quadrant of his abdomen, which would not indicate appendicitis. Basically, she is saying getting it wrong does not mean she did not make the right call based on the information she had available. She also argues that the blood tests conducted in the initial emergency room visit did not indicate infection. The jury finds in the favor of the plaintiff, agreeing that the defendant did deviate from the standard of medical care, and awards the plaintiff $450,000.
  • 2012, Pennsylvania: $75,000 Settlement. An elderly man is admitted into Pittsburgh Medical Center’s emergency room after complaining of lower abdominal pain. He is observed by the emergency room physicians who, although he is initially given a differential diagnosis of acute appendicitis, choose to conduct an appendectomy 15 hours after his arrival. Unfortunately, the surgery came too late and the appendix had already ruptured. The man suffers multiple complications from the ruptured appendix including bowel obstructions, infection and sepsis. He ultimately passes three weeks following the surgery. The elderly man’s estate brings suit of medical malpractice against the emergency room physicians for failing to treat his appendicitis as an emergency. They claim the defendants’ failure to order a surgical consult at an earlier time, which resulted in inflammation and rupture. The parties eventually settle in Allegheny County for $75,000, underscoring the fact that this might not have been the best plaintiffs' case by any stretch.
  • 2012, Massachusetts: $1,500,000 Settlement: A teenage girl is in need of an appendectomy after being diagnosed with acute appendicitis. While in the process of performing a laparoscopic surgery, the general surgeon discovers a large amount of blood pooling in the girl’s abdomen and converts the procedure to a mid-line laparotomy. A vascular surgeon is called for a consultation when a 1.5 cm laceration is discovered in the right common iliac vein and the inferior vena cava. The surgeons repair the laceration and the girl is sent to recovery. Shortly after the surgery, the girl begins to experience hematoma and pulmonary emboli. Yet, for some reason, both surgeons choose to not act on her complications and the teenager is sent to another facility. Three days after her arrival she is required to undergo a second procedure for obstructions to the iliac vein and inferior vena cava. The mother, acting on her daughter’s behalf, brings suit to the general and vascular surgeon for failing to timely respond to post-operative complications that caused the girl pain, suffering and emotional distress. Both doctors deny liability. The general surgeon argues he is not liable as he is not trained in complications associated with vascular surgery. The vascular surgeon also denies liability, claiming that there were no problems directly associated with his surgery. Mediation is conducted and the parties agree to a confidential settlement for $1,500,000.
  • 2012, California: $250,000 Settlement: A 49 year-old man is experiencing pain in the lower right quadrant of his abdomen. He visits the emergency room where he is given a CT scan of his abdomen and a diagnosis of a ruptured acute appendicitis. An appendectomy is not conducted until 12 hours following the initial diagnosis. One week later, a second CT scan is conducted after the man begins to experience continued pain in his abdomen, which at that time, was distended. He is also lethargic and his white blood cell count is measured to be at a critical level. Two days later, a superficial exploratory procedure is conducted and the performing physician drains an infected hematoma, but does not enter the abdominal cavity. Just another two days following the exploratory surgery, it is discovered that fecal matter has leaked out of the abdominal incision. A second surgical consult is requested, discharging the initial doctor from the man’s care. After the second consultation, an intricate leak repair surgery is conducted. Finally, after all the complications the man had to go through from the first two surgeries, his condition improves. The man sues the original doctor for medical malpractice, claiming the defendant violated the standard of care on two separate occasions. He claims the first count of negligence occurred when the defendant failed to rule out the anastomotic leak during the second CT scan. He affirms that had the doctor observed the symptoms and scan results, a leak would have been listed as a differential diagnosis. The plaintiff claims the second act of negligence occurred when the defendant chose not to open the abdominal cavity to conclusively rule out the anastomotic leak. The defendant denies the allegations, asserting that the plaintiff’s post-operative conditions did not indicate an anastomotic leak and the conditions were constant with a hematoma. He argues that an anastomotic leak can occur in the abdomen without any sort of negligence and that the leak occurred sometime between the exploratory surgery and the surgery conducted by the second doctor. The parties agree to go to mediation where a $250,000 settlement is agreed upon.
  • 2012, New York: $2,599,000 Verdict. A mother of a 10 year-old girl is growing concerned as her daughter begins to exhibit severe abdominal pain and decides to take her to her primary pediatrician. The pediatrician conducts a quick examination of the child, diagnosis her with a stomach virus, and sends her home with a doctor’s note for school. Two days later, the child is taken to the emergency room where it is discovered her appendix has ruptured and is in need of emergency surgery. Because the appendix had already ruptured, it was too late to conduct a laparoscopic procedure and the child had to undergo an open surgery to remove the appendix. She is catheterized for one week after the surgery and unfortunately, due to the extended catheter use, develops a UTI. She is required to spend two weeks in the hospital for both post-operative treatment and treatment for the subsequent UTI. The child is now permanently at risk for additional future UTIs as well as abdominal adhesions. The plaintiff’s mother, acting on her behalf, brings suit to the pediatrician for medical malpractice, claiming the pediatrician failed to conduct a proper examination that would have diagnosed the girl with appendicitis. She claims that the girl – whose father had only recently died – experienced heightened levels of fear during the entire ordeal and is now very self-conscious about the surgical scar. The defendant pediatrician argues that when the child was presented to her, she was indicating signs of a stomach virus as there was no tenderness upon observation. Bronx County jurors award $500,000 for past pain and suffering, $80,000 for future medical bills for 45 years, and $2,000,000 for future pain and suffering for 45 years.
  • 2012, New York: $125,000 Settlement. 10 year old female plaintiff is misdiagnosed by defendant Lawrence Hospital Center. The plaintiff claims that the misdiagnosis caused her conscious pain and suffering as well as an appendectomy. Defendant denies liability and argues that and negligence was due to the physical condition of the plaintiff and the culpable conduct of her parents. The parties reach a settlement in Bronx County for $125,000.
  • 2011, New York: $180,000 Verdict. Patient sees his doctor at Mount Sinai Hospital complaining of the symptoms of appendicitis. Instead, the doctor diagnoses him with gastritis and sends him home with a prescription drug that only masks the symptoms. Patient returns seeking assistance, but is again sent home with the wrong diagnosis. Due to the delay in treatment, plaintiff suffers a ruptured appendix, intra-abdominal disease and infection, dense adhesions, and pus formation. Plaintiff alleges that the physician failed to properly interpret the CT scan, X-ray, ultrasound, abdominal sonogram, and rectal exam they performed on him. The defendant generally denies the plaintiff’s claims, but a New York County jury awards him $180,000 for pain and suffering.
Medical Malpractice Claims in Maryland

If you or someone you love has suffered as the result of a medical misdiagnosis or failure to properly treat an appendicitis, call us at 800-553-8082 or get a free on-line no obligation medical misdiagnosis consultation.

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