Case Study-Cause or Coincidence

Today's case involves a thirty-five year old builder.  He fell off the scaffolding and was struck on the right side of his abdomen by one of the planks.

He sustained some bruising in the area among other injuries, including several fractures.  There was no particular abnormality noted in his abdomen, and he was allowed home after two days.

Approximately six weeks later, he developed acute appendicitis.  He attended the hospital after 3-4 days of abdominal pain and was found to have an appendix mass, which is an abscess around the appendix.  This was treated at a conservatory with antibiotics, and the mass gradually resolved over 2-3 months.  The question was whether or not the appendicitis was related to the subject incident.

There are sporadic reports in the literature of appendicitis developing within a matter of days after such an incident, the most famous case of which was Harry Houdini, who, after allowing someone to punch him in the abdomen several times, went on to develop acute appendicitis within 24-48 hours.

There have been several suggested mechanisms, including direct trauma to the appendix, overpressure from the large bowel (cecum) into the orifice of the appendix, literally ‘blowing it up’ or swelling of the appendix, closing its lumen, resulting in obstructive appendicitis.  However, there is no proven cause of the relationship.  

It has been accepted, through ‘Fowler’ criteria, that this can happen in the early phase after an abdominal injury.  There must be no past history of appendicitis, and it should develop ‘merging’ into the pain from the original injury within a matter of days up to a week.  

There is obviously a suspicion that appendicitis may have developed from abdominal trauma when the two events are in close temporal proximity; however, there is no proven mechanism of injury that can be suggested if appendicitis develops more than 2-3 weeks after the subject incident.

The case falls on the lack of proof of a direct causative link, which has possibly been shown to be causative in the early phases but not later on.

MDU figures for 2018 show that less than one in six actions in medical negligence actually succeed with the vast majority failing on the grounds of causation. It must be remembered that subsequence is not the same as consequence. 

Initial screening is therefore essential to manage client expectations at an early stage. This avoids unnecessary effort and costs for all concerned. Too many cases are taken to Court with no chance of success. This is stressful for both the client and their legal advisor and indeed for the medical personnel involved.

For fast and effective screening of all potential medical negligence cases contact 

Peyton Medico Legal Services now on 028 87724177 or email rpeyton@rpeyton.com