Gorovitz & Borten, P.C.
Attorneys at Law

550 Cochituate Road, Suite 25
Framingham, Massachusetts
01701
Tel: (781) 890-9095
Appendicitis
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:

  • Periumbilical pain
  • Right lower quadrant pain
  • Anorexia
  • Nausea
  • Vomiting
  • Diarrhea

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:

  • Rebound tenderness
  • Pain on percussion of the right lower quadrant (abdomen)
  • Abdominal rigidity
  • Abdominal guarding
  • 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)
  • C-reactice protein
  • Ultrasonography (US)
  • 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;

  • Wound infection
  • Dehiscence
  • Bowel obstruction
  • Abdominal and/or pelvic abscess
  • Death

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.
Contact Information
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possible), please contact us by phone, fax or e-mail with your question or
concern.

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