Fatal Appendicitis Could Have Been Detected Earlier: Pediatric Surgery Expert

Case Overview

This case involves a 4-month-old girl who presented to the ER with multiple symptoms, including a visibly distended abdomen. An ultrasound was performed, however it was noted that the testing did not visualize the appendix. Because of this, and the young age of the child, the surgeon ruled out appendicitis and considered other explanations for the patient’s condition, which continued to deteriorate over the course of the next few days. Eventually, the patient died in the hospital, with the cause of death identified as a ruptured appendix. It was alleged that the patient should have been diagnosed with and treated for appendicitis shortly after her arrival at the hospital.

Questions to the Pediatrics expert and their responses

Do you have extensive experience treating patients who present with signs of appendicitis?

I have extensive experience in both the diagnosis and treatment of patients with both simple uncomplicated appendicitis and complex cases. I perform approximately 100 appendectomies every year, and have done so since 2006. I am a pediatric surgeon champion for the American College of Surgeons national surgical quality improvement program (NSQIP), and our institution has been participating in the appendectomy pilot study which has established best practices for pediatric appendicitis.

Are you familiar with the sign and symptoms that are present when appendicitis is the issues?

Appendicitis is uncommon in children under 6 months of age, but it should always be considered as part of the differential diagnosis. An abdominal ultrasound should be interpreted with caution. Acute appendicitis can only be excluded on ultrasound examination if it is clearly visualized, and normal in appearance (normal diameter, compressible, with no sonographic evidence of inflammation).

About the expert

This double board certified general surgeon/pediatric surgeon earned a BS in Biology from Trinity College, an MD from the University of Connecticut School of Medicine, and a MPH from the University of Michigan School of Public Health. Additionally, he completed residency training in General Surgery at University of North Carolina Hospitals and fellowship training in pediatric surgery at Arkansas Children's Hospital. He is a fellow in both the American College of Surgeons and the American Academy of Pediatrics. He has authored more than 25 publications in his field, and is currently an attending surgeon at a children's hospital, in addition to his role as assistant professor of surgery and pediatrics at a major university medical center in the northeast.

E-009839

Specialties:

Pediatrics