Complications Due to Delayed Diagnosis of Ruptured Appendix

This case study examines a delayed diagnosis of a ruptured appendix in a pediatric patient, highlighting the importance of standards of care in Pediatric Emergency Medicine.

ByWendy Ketner, M.D.


Published on February 5, 2024

Doctor pointing at ultrasound scan

Case Overview

This case study delves into an incident involving an adolescent who presented to the Emergency Department (ED) with severe abdominal pain and nausea. The patient was initially evaluated by a surgical consult, diagnosed with gas, and discharged. However, the patient returned to the ED the following day, underwent an ultrasound, but was again sent home.

On their third visit three days after the initial presentation, they were finally diagnosed with a ruptured appendix that had led to complications. This case raises significant questions about the standards of care in Pediatric Emergency Medicine.

Questions to the Emergency Medicine expert and their responses


As a Pediatric Emergency Medicine attending physician, how often do you evaluate pediatric patients presenting with severe abdominal pain?

In my 15 years of experience as a Pediatric Emergency Medicine attending physician, I encounter patients with these symptoms many times per week during every clinical shift I work.


What are common tests used in evaluating intrabdominal pathology in a 14-year-old patient?

Ultrasound is typically the first imaging modality used and may be followed by either CT or MRI if the diagnosis remains unclear. Lab work may include CBC and CRP for help in diagnosing appendicitis, but can also include other labs such as CMP, lipase, and urine studies depending on the scenario.


Can you elaborate on how a delay in the diagnosis of a ruptured appendix might impact an adverse outcome?

Certainly. Firstly, a delay in diagnosis could convert a non-ruptured appendicitis into a ruptured case. Additionally, the longer a ruptured appendicitis case goes untreated, it becomes more challenging to treat both medically and surgically, and duration of symptoms will be longer.

There's also an increased risk for future complications, such as adhesions/obstruction, abscess formation, or infertility in female patients.

About the expert

This expert is a highly experienced pediatric emergency medicine specialist with over a decade of experience. They hold board certifications in pediatrics and pediatric emergency medicine, underpinned by an extensive educational background from prestigious institutions. Currently, they serve as the medical director of pediatric services and urgent care at two different medical centers, while also holding professorships at both an osteopathic medical school and an Ivy League-affiliated medical center.

Expert headshot



About the author

Wendy Ketner, M.D.

Wendy Ketner, M.D.

Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.

Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.

Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.

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