Delays in diagnosis of appendicitis can cause long term health consequences

Posted: 12/01/2016

Appendicitis is one of the most common causes of acute abdominal problems in the UK and it is estimated that around 10% of the UK population will develop acute appendicitis. Appendicitis can occur at any age but it is most common between the ages of 10 and 20 years.

However, despite the prevalence of this condition, the clinical negligence team at Penningtons Manches LLP deals with many cases involving delayed diagnosis and treatment of appendicitis, which can have significant consequences on a patient. Difficulties in diagnosing appendicitis can often arise at the very early stages of the condition as many patients present to their GPs and/ or A&E with generalised abdominal pain. The cause of this pain can often be attributed to less severe conditions such as gastroenteritis and, in children, it can be mistaken for a condition called mesenteric adenitis. However, as the appendicitis progresses, the pain tends to become more localised in the lower right side of the abdomen - the "Right Iliac Fossa" and pain in this area tends to be the 'hallmark' of appendicitis. There are other symptoms associated with appendicitis, such as vomiting and diarrhoea and a high temperature, but an appropriate abdominal examination is often key in diagnosing the condition.

While some scans, such as a CT scan, can help confirm or rule out a suspicion of appendicitis, it is common knowledge among doctors that a diagnosis of appendicitis is made by way of a clinical assessment. This involves taking a full history of the patient's symptoms and how the symptoms have worsened and by performing a physical examination of the patient. If, following such an assessment, a strong index suspicion of appendicitis remains, a patient will often be listed for surgery which can often be carried out by keyhole (ie laparoscopic) surgery. This is a far less invasive option for surgery than that of open surgery which involves making a large incision in the abdomen.

Thankfully, many cases of appendicitis are caught relatively early on and the condition can be treated by removing the appendix with keyhole surgery. Patients often make a very good recovery following key hole surgery and do not normally experience future complications.

But complications can arise when appendicitis is left undiagnosed or untreated for a prolonged period of time as the appendix can perforate (rupture), which can lead to sepsis. Once the appendix ruptures, the more invasive form of open surgery (rather than keyhole surgery) is often needed. This carries the consequences of sustaining more extensive scarring, a prolonged period of recovery, and an increased future risk of hernias developing at the site of the open surgery. Of significant concern to women of child bearing age, there is a risk of fertility compromise with prolonged exposure of abdominal sepsis, so the importance of early diagnosis and treatment cannot be stressed enough. Unfortunately, many patients are often subject to a very delayed and/or inadequate assessment and by the time a diagnosis is reached perforation has already occurred.

Naomi Holland, clinical negligence solicitor at Penningtons Manches, comments: "Many of our clients have experienced delays in obtaining the appropriate diagnosis and treatment of appendicitis, often despite repeated attendances at their GP and/or hospital. They have often had a very traumatic experience and suffer long term consequences. Many of our clients also present with the typical features of appendicitis and a diagnosis should have reasonably been made, but for various unacceptable reasons, there were significant delays in making a diagnosis and carrying out the much needed surgery."

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