In October 2011, the plaintiff underwent a laparoscopic appendectomy by the defendant. The appendix removed was measured in the pathology department as being 4.5 cm in length, and by all accounts the surgery was successful and routine.
More than two years later on May 15, 2014, the plaintiff went to a different hospital complaining of severe abdominal pain. An initial CT scan showed no abnormalities, but a scan taken the following day suggested possible stump appendicitis.
The plaintiff underwent a second laparoscopic appendectomy on May 16, 2014, performed by a different surgeon, whose operative note confirmed a diagnosis of stump appendicitis. The appendix measured 4.1 cm in length.
Plaintiff’s expert claimed the doctor who performed the surgery in 2011 was medically negligent in failing to completely remove the entire appendix. At trial, plaintiff presented expert testimony that the defendant surgeon was professionally negligent. Plaintiff also argued that the CT scans taken at each hospital did not show evidence of two appendices and that scans from the second hospital showed evidence of stump appendicitis.
The defense presented evidence that the appendix removed at the second hospital was not a stump appendix but more likely a duplicate appendix. The defense pathology expert showed, from microscopic slides, that the distal area of the appendix removed at the second hospital did not show evidence of any prior surgical intervention. The defense surgery expert testified that the period of time between the two bouts of appendicitis also favored a duplicate appendix, as opposed to stump appendicitis.
Further, the radiologist who interpreted the CT scan in October 2011 (which showed appendicitis) measured the length of the appendix at that time as equaling no more than 7.1 cm. Given the two measurements obtained in the respective pathology departments (totaling 8.6 cm.), judged against the CT measurement (at most, 7.1 cm) the defense argued that the patient likely had a duplicate appendix.
The defense also argued that even if the appendix removed at the second hospital was a stump appendix, the defendant still complied with the standard of care, as the likely explanation for the stump was that this area of the appendix was adherent to the cecum as of October 2011. Any alleged failure to recognize this did not constitute medical negligence.