Appendix Mass
If your appendix mass was not diagnosed in a timely manner, causing you to suffer serious complications, you could be entitled to pursue a claim for compensation. Contact us today to find out more.
Appendicitis
Appendicitis is when the appendix becomes inflamed. The appendix is a vestigial organ, meaning it no longer serves any purpose. It is situated on the pole of the caecum, which is generally considered to be the beginning of the large intestine.
Appendicitis is a common condition. A classical presentation is an acute presentation over a period of days. The appendix, once it becomes inflamed, will result in a pain around the belly button. As the inflammation spreads through the appendix to involve other structures, such as the abdominal wall, the pain will move to the site of the appendix in the right lower quadrant of the abdomen.
Thus, typically, a patient will experience pain around the belly button, and this pain will move within hours to the right-hand side of the tummy. The pain will usually be constant, unremitting and quite severe. Often this leads the patient to seek medical advice urgently.
Recognising appendicitis
A patient with appendicitis will feel unwell. They will have a loss of appetite, occasional nausea, and occasional vomiting. Depending upon the site of the appendix in relation to other intra-abdominal organs, a patient can present with other symptoms.
Examination of a patient with appendicitis normally reveals a mild tachycardia (increased heart rate), mildly high temperature, and tenderness over the site of the appendix in the right iliac fossa with guarding. Guarding means there is muscular rigidity over the site of the appendix.
A blood test will show an elevated white blood cell count and an elevated C-reactive protein (and indication of inflammation). A urine test will rule out the presence of a urinary tract infection.
Evolution of appendicitis
The evolution of appendicitis can be extremely variable. It depends on many factors including the position of the appendix within the abdominal cavity, the virulence of the infection and the patient's immune response to it. Most importantly, it depends upon the anatomical situation of the appendicular artery that supplies the appendix the appendix with blood and oxygen.
A very mild case of appendicitis can settle spontaneously. Indeed, patients who present with appendicitis often have a history of a previous similar-type illness that settled spontaneously. A more virulent infection will, however, lead to significant inflammation of the appendix and this causes the appendix to swell. The ultimate course of appendicitis will then depend upon the anatomical site of the appendix and the appendicular artery.
Severe/normal appendicitis
Most commonly the appendix lies behind the caecum and ascending colon where it is relatively protected and can become walled off by the body's natural defence mechanisms. The appendicular artery ordinarily runs in the free edge of the mesoappendix and ascending branches intermittently to the appendix.
However, in some individuals the appendicular artery runs for most of its length within the wall of the appendix and therefore is vulnerable due to swelling of the appendix. This will block the blood vessels and lead to gangrenous changes and perforation of the appendix within hours. This is quite rare. The majority of patients will have a normal anatomical situation and their appendicitis will progress over a period of days.
Mild appendicitis and appendix mass
A very mild case of appendicitis which is not treated does lead to the body's own defence mechanism attempting to treat the inflammatory process. The appendix becomes surrounded by adjacent structures such as other loops of the bowel and fatty membranes. This can form what is known as an appendix mass.
A patient with an appendix mass will have tenderness in the lower abdomen, active bowel sounds and pain that is made worse by eating. A blood test will show raised inflammatory markers. These clinical signs are consistent with an inflammatory process in the lower abdomen and warrant further investigation.
Diagnosing and treating an appendix mass
A patient with the clinical signs of an appendix mass should be admitted to hospital. There further investigations should be carried out, including blood tests, abdominal x-ray, and possibly an ultrasound and CT scan. This should reveal an appendix mass.
The standard treatment for an appendix mass is to manage this conservatively by means of broad-spectrum intravenous antibiotics and giving the patient minimal oral intake. Under such a regime, within five to seven days the inflammatory process will usually settle allowing a patient to be discharged home. A discussion can then be had as to whether the appendix remnant needs to be removed at some point in the future usually via a laparoscopic technique.
However, data in the literature suggests that only 20% of patients will have further problems due to the appendix remnant. Therefore it is unlikely that a patient would need a future appendicectomy.
Appendix mass and abscess
In some patients who develop an appendix mass then an abscess can form within it. If this occurs then the abscess will need to be drained, with the drain being inserted either under CT guidance or by an open surgical procedure. If surgery is required, it is normally a fairly minimal procedure undertaken by a small incision over the appendix mass in the right iliac fossa.
Delayed diagnosis of an appendix mass
If an appendix mass is not diagnosed and treated the consequences can be very troubling, as the inflammatory mass will continue to grow. Eventually the inflammatory mass may involve the right colon, the terminal ileum and the transverse colon. The patient will then require extension resection of the colon, with a large part of the colon having to be removed.
Due to the extensive nature of surgery it is likely that a patient will have significant intra-abdominal adhesions and these may cause problems in the future by means of a small bowel obstruction. A patient will also be left with a midline wound and will run the risk of developing an incisional hernia.
Medical negligence claims
If a patient develops these complications due to a delay in diagnosis, there may be grounds for a medical negligence claim. This is because medical practitioners should recognise the signs of an inflamed abdomen and admit a patient to hospital. A reasonable standard of surgical care would have ensured an appendix mass was diagnosed. This would then have been managed conservatively with intravenous antibiotics for a week to 10 days. There is a 20% chance a patient will develop further problems, but serious complications would certainly have been avoided.
If medical practitioners fail to achieve this standard of care, causing a patient to suffer unnecessary harm, there will be a case of medical negligence. Contact us today for more information.
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