Appendicitis: The Difference Between Men, Women and Children

In men, appendicitis usually begins with a cramping wave-like mid-abdominal pain, that after number of hours, usually within a day, the pain is then localized in the right lower side of the abdomen.

The cramping pain is because the appendix is being blocked by a concretion, a solid mass of feces, and that cramping pain is caused by the contractions of the appendix trying to push it out.

But once the block remains, the protein mucus (germ food) in the appendix allows the bacterial germs proliferate. This causes the appendix to become inflamed from acute infection. And that infected appendix touching the inside of the abdominal cavity, its peritoneal lining’s thousands of tiny nerves, causes the localized pain.

In a woman, it is the exact same situation with appendicitis. However, making the correct diagnosis is complicated by the possibility of the infection being caused instead by pelvic inflammatory disease, usually caused by the bacterial germ gonorrhea, infecting the fallopian tubes. Here instead of a low-grade fever of approximately 100°, it’s usually between 102° to 103°. During a pelvic examination, by pushing on the mouth of the womb, the cervix, this causes severe pain. That helps distinguish between appendicitis versus infected fallopian tube‘s.

In children, the sequence of events is much faster, usually within 12 hours to one day until the rupturing of the appendix occurs. And unlike in adults, the omentum, the fat pad that hangs down from the stomach and large intestine is much less developed, and therefore infection can spread throughout the abdominal cavity, which is called peritonitis. In adults, it’s more likely that this fat pad will wall off and then localize the infection causing an abscess, rather than a widespread and potentially deadly infection, peritonitis.


Surgical Mesh Complications in Hernia Repairs

A hernia is a weakness in the abdominal musculature, through which the intestines can protrude. For many years, since the late 1800s, surgeons have been repairing this weakness by suturing the layers of the adjacent fibrous flesh together.

However, because of the low but significant failure rate of the original suturing to hold, requiring a repeat hernia operation, which by itself is not a departure from the accepted standards of care, or when an operation was required to repair a very large hernia, surgeons have been using a plastic woven cloth, a mesh. This allows the body’s scar tissue to grow into this material, to serve as an internal girdle, a buttress, to decrease the failure of the surgical repair.

Whenever any foreign material is inserted into the human body, there is an increased risk of infection. The presence of foreign material makes it much more difficult for the body to fight off any infection. Even with the most sterile procedures, there is that very small risk of infection, including from the human body itself, such as from brushing teeth, where germs can enter the bloodstream and “seed out” at that surgical mesh site.

Furthermore, whenever any foreign material enters the human body, there is a small propensity for the body to eliminate it, as if it were a splinter working its way through the skin.

The standard of care requires that the surgeon explain the need for the use of the mesh to lower the failure rate for the hernia repair. And during this discussion, the surgeon also needs to inform the patient of the slight increased risk for infection, as well as the possibility for the foreign substance to work its way out of the body.

Involve Your Medical Experts Early For Optimum Case Outcomes

“I Probably Should Have Contacted You Sooner…”

This opening line, on the phone or in office, strikes apprehension in your medical experts—or any expert, for that matter. Involving your experts as early as possible can quickly identify non-meritorious cases, save time, streamline case issues, improve case outcomes and the attorneys’ bottom line.

I recall a medical malpractice case several years ago involving a malfunctioning piece of life support equipment and multiple medical and nursing professionals, as well as falsified medical documentation.  By the time the attorney contacted me late in the process as a Nurse Expert, the medical equipment company had been excluded from the case, and it was too late to include several of the medical and nursing professionals responsible for significant breaches in the standard of care.  

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Saving Your Malpractice Case

The Fact Pattern

A 62-year-old male, Mr. Block, was in good health and had been a patient of Doctor Byrnes for many years. The patient had a history of rectal polyps which were removed in the operating room on several different occasions. The polyps continuously recurred despite adequate resection by Doctor Byrnes. The patient was compliant in every way and had a good relationship with Doctor Byrnes.

During a routine yearly visit, Doctor Byrnes found another rectal polyp. It looked suspicious and worrisome for a possible malignancy. Doctor Byrnes felt that a wider, more extensive local resection would be necessary. He told this to the patient, and the patient understood and agreed. Doctor Byrnes told Mr. Block that he (Doctor Byrnes) was now referring his operative patients to his younger associate, Doctor Madding. Doctor Madding examined Mr. Block. Doctor Madding concurred with the diagnosis and the proposed treatment plan. He established a rapport with the patient, explained the treatment plan and discussed potential complications with Mr. Block. In fact, Doctor Madding met twice with Mr. Block and did his best to explain the upcoming operation and tried to put Mr. Block at ease.

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