Appendicitis Misdiagnosis 

Appendicitis is a common condition. Doctors know the symptoms. They know how painful and serious it can be – and they know the consequences of delayed diagnosis or misdiagnosis. But that does not stop some patients from falling victim to medical negligence.

Around 50,000 people need hospital treatment for appendicitis every year in England. It can occur at any age but particularly among people aged between 10 and 20 years old.

Unfortunately, appendicitis is not always diagnosed correctly. Its symptoms can be mistaken for severe irritable bowel syndrome (IBS), constipation, diverticulitis, gastroenteritis, bladder/urine infections, Crohn’s disease, kidney diseases or an ectopic pregnancy.

The appendix is a 5-10cm pouch connected to the large intestine; it serves no known purpose. This pouch can become blocked or damaged – leading to inflammation and swelling. If left untreated it can burst with severe and potentially fatal consequences.

Appendicitis can be caused by a blockage at the opening of the pouch. Other causes include:

• enlarged tissue in the wall of the appendix (caused by infection elsewhere in the body – notably in the gastroenterinal tract)
• inflammatory bowel disease
• stools, parasites or growths
• abdominal trauma.

The first sign of appendicitis is usually a pain in the middle of the tummy. In the early stages the pain may come and go – but within a few hours the pain will be continuous.

The area of pain then moves to the lower right of the abdomen. Sometimes patients first experience pain near the navel – this pain then moves lower. Pressing on the affected area, coughing or walking can make the pain worse.

Did your GP or hospital doctor fail to identify and act on these early warning signs? 

The initial pain of early appendicitis is swiftly followed by one or more of the following symptoms:

• nausea and vomiting
• loss of appetite
• constipation or diarrhoea
• fever/high temperature – 99°F (37.2°C) and 100.5°F (38°C) – and a flushed face
  inability to pass gas.

Your hospital doctors should run tests to confirm whether or not your symptoms are caused by appendicitis or another condition. These tests can include a physical examination (applying gentle pressure to the painful area).

Clinicians may run blood tests to determine whether or not you have a high white blood cell count (this can indicate an infection) and urine tests to check that your pain is not being caused by a kidney stone or a urinary tract infection (UTI).

You may also undergo an X-ray, an ultrasound or a computerised tomography (CT) scan – but they are not mandatory. And with ultrasound in particular the quality of the results can depend on the skill of the operator.

Did your doctors fail to run a scan? Did this result in your appendicitis being misdiagnosed or diagnosed late?

Removal of the appendix – an appendectomy under general anaesthetic – is the recognised way to treat appendicitis. It is considered to be a ‘safe’ operation. The surgery could be either open or the keyhole (laparoscopy) method. Hospitals prefer keyhole surgery because it is less

invasive, has fewer risks and the recovery time is faster.

Keyhole surgery involves making three or four small cuts in the tummy, inflating the abdomen with gas, using small surgical tools to remove the appendix then closing the wound with dissolvable stitches. If the surgeon closed the incision with normal stitches, they must be removed at a later date – usually within 7 to 10 days at your GP surgery.

Open surgery may be required if your appendix has already burst and there is a risk of the infection spreading to other organs. It is also the preferred option if you have previously had abdominal surgery.

But – as with any surgical procedure – there is always the risk of something going wrong:

• anaesthesia – the patient experiences severe pain, damage to the teeth or larynx, cardiovascular collapse, breathing difficulties, brain damage, gas blockage in the blood vessels, fever and death.
• internal bleeding
• infection
• damage to the nerves or other organs.

There can be minor complications in around one or two per cent of cases – usually related to infection. Major complications occur in one in 1,000 cases: typically damage to the bowel, bladder or complications arising from the use of CO2 gas during the operation.

Sometimes having your appendix removed does not cure the problem – you may still be in pain weeks after your operation. This could be due to stump appendicitis (a reoccurrence of the inflammation).

Stump appendicitis is a rare complication. It occurs when the surgeons remove only part of the appendix – leaving a residual stump which can then become inflamed, leading to repeated instances of pain.

The rarity of this condition can make it less likely to be diagnosed. There is also an increased risk that it could be misdiagnosed as another condition.

Your appendix could burst if the inflammation is not diagnosed correctly and treated in time.

If this happens, bacteria will spread and infect your peritoneum (abdominal lining). This condition is called peritonitis. Your internal organs may also suffer damage. Peritonitis can kill.

Failure to treat the condition swiftly can also leave you with long-term health problems. Typical symptoms of peritonitis include severe and continuous abdominal pain. You will feel nauseous or be sick. Other symptoms include:

• high temperature
• rapid heartbeat
• rapid breathing and shortness of breath
• abdominal swelling.

But peritonitis is not always caused by appendicitis. Other causes include a burst stomach ulcer, pancreatitis, surgery complications, kidney dialysis complications, cirrhosis, various digestive conditions – this can lead to possible misdiagnosis or delayed diagnosis.

Peritonitis is not the only appendicitis complication. In one-in-500 patients, an abscess of pus can form around the burst appendix. It is possible to treat this condition using antibiotics – but the usual method is to drain the pus from the abscess.

In this case, you should receive a CT scan or an ultrasound. Did the hospital fail to scan you correctly? Did you have complications after having your appendix removed?