Appendicitis is a medical and surgical emergency with significant morbidity and mortality which increases with diagnostic delay. The primary cause of appendicitis is the obstruction of the lumen of the appendix which causes distention , bacterial invasion and rupture if it remains untreated. Appendicitis affects approximately 7% of the population in the United States. Perforation is higher in individuals younger than 18 years of age and older than 50 years. The overall mortality is less than 1% and is directly related to the delay in diagnosis.
The most common causes of obstruction of the lumen of the appendix are fecaliths and lymphoid follicle hyperplasia. Fecaliths are the small particles formed by fecal debris and calcium salts that accumulate within the appendix. Lymphoid hyperplasia is associated with inflammatory diseases of the gastrointestinal tract such as: Crohn’s disease, gastroenteritis, mononucleosis.
Variations in the position of the appendix make the presentation of appendicitis a clinical challenge. Symptoms associated with a suspected appendicitis include:
Right lower quadrant pain
Symptoms usually are less than 48 hours in duration (longer in elderly people) and increase prior to perforation. Pain that migrates from the periumbilical area to the right lower quadrant is characteristic and highly suspicious of appendicitis. Some symptoms are associated with a localized peritonitis (peritoneal irritation) that is usually present in patients with appendicitis. Symptoms associated with localized and advanced peritonitis include:
Pain on percussion of the right lower quadrant (abdomen)
Pain in the right lower quadrant associated with coughing
Evaluation of a patient suspected of suffering from appendicitis requires a high index of suspicion. Laboratory and radiographic testing helpful in the diagnosis of appendicitis include:
Complete blood count (CBC)
Computed tomography (CT)
Barium enema studies
Treatment of choice for a patient diagnosed with appendicitis is surgical intervention. While anecdotes abound of successful non-surgical treatment with antibiotics, consultation and treatment by a competent surgeon is the most prudent course to follow. The goals of treatment is to eradicate infection and prevent dissemination and peritonitis complications. Perforation of the appendix with intraperitoneal spillage of intestinal content is the most feared complication associated with this appendicitis.
Surgical treatment of appendicitis prior to rupture is associated with fewer postoperative complications than surgical intervention following appendiceal rupture. Complications associated with surgical treatment of appendicitis include;
Abdominal and/or pelvic abscess
In up to 10% of symptomatic adult patients, the diagnosis of appendicitis is not made during the initial visits to a physician (emergency room, private office). Failure to diagnose appendicitis is one of the leading causes of successful litigation against emergency room physicians in the United States.
If you believe that you or your loved have been misdiagnosed, are victims of a delayed diagnosis of appendicitis or wrongly treated for and suspect the perforation of the appendix may be the result of a medical provider’s error that was diagnosable, avoidable and/or preventable, you may have a valid cause of action. The injury may be the result of a medical provider's mistake in handling your condition and the result of medical negligence. Dr. Borten has over 35 years of experience as an obstetrician and gynecologic surgeon to fully evaluate the merits of your potential case. Allow the Boston area medical malpractice attorneys at Gorovitz & Borten help you assert your rights and get the compensation you deserve.
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