Delay in diagnosis of appendicitis

On 14th November 2015, the Claimant (a minor) was playing with his cousin when he fell from the bed and elbowed himself in the left side of the abdomen. Following the incident, the Claimant suffered severe pain in the abdomen and vomited. The Claimant attended the Defendant Hospital on the same day where he underwent a chest x-ray. He was observed overnight and then discharged from hospital with a diagnosis of musculoskeletal pain. It is noted in the medical records that an ultrasound scan was considered but not performed. The circumstances of a fall out of bed onto his left elbow resulting in injury to the abdomen were also recorded, but the possibility of splenic injury was not been considered.

The Claimant continued to experience significant pain in his left-hand side and an ambulance was called on 16th November 2015 however, the Claimant was not taken to hospital as his mother informed the paramedics of the previous day’s hospital attendance and outcome. The out of hours GP was contacted on 16th November 2015 and  symptoms were discussed.

On 17th November 2015 the Claimant continued to suffer from severe pain in his left hand side and was noted to be pale, nauseous, and vomiting. Another ambulance was called, and he was taken back to Hospital where a CT scan was performed, and he was diagnosed with a laceration to the spleen, internal bleeding and extensive free fluid within the abdomen and pelvis.

The Claimant was monitored in ICU for two days for hypovolemic shock and developed a left sided reactive pleural effusion. He remained a further 3 weeks in hospital and was discharged on 2nd December 2015 with a 4-week further course of antibiotics.

Following discharge from hospital, the Claimant continued to experience left-sided abdominal pain, which was sometimes shooting in nature, and in February 2016 had a further ultrasound scan which showed confirmed reduction of the previously diagnosed splenic sub-capsular haematoma. The scan was repeated in June 2016 showing a further decrease in size and a repeat scan on 24th April 2017 showed the haematoma to be fibrosing, at which time the Claimant’s symptoms of abdominal pain were continuing. He re-attended in 2019 for ongoing symptoms of ‘a stuck rib’ which were attributed to scar tissue further to the laceration.

Allegations of Negligence

On 14th November 2015, Claimant’s care fell below a standard of reasonable competence in several respects.

Instructing Solicitors obtained opinion and report from Consultant Gastroenterologist expert who averred that the Claimant’s incident history, symptoms and physical findings on 14th November 2015 should have triggered suspicion for the possibility of splenic injury and the Defendant’s failure to suspect splenic injury and undergo further investigations was therefore negligent and amounted to a breach of duty.

The expert opined that the Claimant was haemodynamically stable upon his index hospital attendance on the 14th November 2015 and the documented history and findings should have been followed by an emergency contrast-enhanced CT scan to rule out a blunt splenic injury and not doing so was negligent. The Defendant’s failure to request for imaging of the abdomen was negligent and amounted to a breach of duty.

Causative Consequences:

As a result of the Defendant’s failure to undergo further investigations and perform a CT scan on 14th November 2015, there was a delay in diagnosis of the Claimant’s splenic injury. Our expert avers that had the splenic injury been picked up during the index admission on the 14th November 2015, the haemodynamic deterioration would have been picked up earlier and the Claimant would have avoided presenting “with hypovolaemic shock” on the 17th November 2015.
During the period of delay in diagnosis of the splenic injury, the Claimant suffered from significant pain in his left-hand side, nausea, and vomiting. The Claimant described this pain as excruciating and unbearable.

Once the Claimant’s splenic injury was diagnosed and treated, the Claimant had to stay in hospital for 3 weeks to recover and was also put on a 4 week course of antibiotics.