"My daughters misdiagnosed ruptured appendix"

About: Dorset PCT Poole General Hospital / General surgery Salisbury District Hospital / General surgery

(as a relative),

My four year old daughter woke up in the early hours of a Monday morning doubled over in pain from her tummy and running a high temperature. We gave her Calpol and kept her off school that day thinking she was coming down with a bug. By 4o'clock that evening she was still unwell so we called the doctors surgery but could not get past the receptionist to talk to a doctor. Throughout that night we controlled her high temperature and pain with calpol but took her to the doctors (without calling first) to wait until it opened. We did not take no as an answer from the receptionist and was taken through to see our G.P. He checked her urine and only found raised keytones (which are present with high temperatures) but was concerned at her pain and tummy tenderness and high constant fever. He called through to Salisbury Hospital and they agreed to see her immediately.

When we arrived we waited and our daughter was given all the same initial checks, temperature, urine and feeling of her tummy. The doctor was concerned that her tummy was distended and that she seemed so unwell and sent her for an x-ray. The x-ray showed a build up of gas but nothing else immediately jumped out as unusual, he told us he could not see the appendix on the screen but seemed unbothered by this. The doctor confirmed that her urine sample showed raised keytones and would be sent off to the lab and results would be available in 48 hours. He proceeded to explain that he would treat it as a urine infection and filled out a prescription.

We returned home reassured that her problems were apparently nothing serious (although instinct was telling us something else). That evening she started vomiting and her temperature was uncontrollable exceeding 40 degrees. We called the emergency doctors out of hours service who I felt reluctantly came out to us, as they said she had been assessed and the medicine for the urine infection would not start to work for 48 hours, but parental instincts took over and we insisted on a doctor attending. The doctor came and seemed to me to be put out. He even left his car running in our drive way so I don't think he was intending to stay long. He said to us he was concerned at her temperature because of her age but insisted we start to give her alternate calpol and ibuprofen every 3 hours to reduce it whilst the urine infection cleared up. This we did not wanting to question the medical advise as surely they know more about this then we do. Over the next 48 hours we diligently gave her the penicilin for the infection and the calpol and ibuprofen as instructed.

I thought her health was not improving but getting worse she could not walk for the pain in her tummy now she had the runs and had not had any appetite for 5 days so was not eating. On the 3rd day of medicines we could not take it anymore and contacted the out of hours doctor again (it was Good Friday) they would not come out to see her and offered us an appointment in Southampton (which is a 45 minute car ride away from us) for that evening at 9pm. By this point we didn't care about protocol and bundled her up and took her straight to the A & E department of the Royal Bournemouth Hospital which was about 15 minutes away from us. We saw a doctor within 2 hours and they sent us to the Poole Hospital Children’s Unit to be admitted for tests. Our daughter was quiet and not coherent. We explained to the doctors at Poole hospital the events and conclusions over that week starting on the Monday morning with her sudden pain to her assessment at Salisbury Hospital and their diagnosis to the out of hours doctors visit and advise bringing us up to date.

They immediately began tests even though it was now getting close to midnight. The blood results came in at 3am the next morning showing dangerously high levels of infection. They did not know where the infection was as the initial urine sample they had taken on the ward was not showing any abnormalities, this was sent through to the lab to confirm. The doctors from Poole hospital contacted Salisbury to find out what type of urine infection they had found as this is what they had been treating her for.

Later we were told that Salisbury Hospital said that in fact after the urine sample had been tested by their lab, they could not find anything. We were fuming they had known this since at least Thursday but had not called us to come back in for further tests to confirm what was causing our daughters pain and temperatures.

Poole hospital immediately started treating her with strong antibiotics through her IV. On the Easter Monday it was clear that not even these strong medicines were working and she was getting worse, they booked her in for an ultrasound to be done that afternoon. The moment we were told by the radiologist that he had found a large abnormal mass (measuring over 4cms wide) attached to her colon we both broke down. The consultant came to see us on the ward as soon as we were back to let us know that they were going to perform an emergency operation on her. He said to us that he and the surgeon believed that the mass was an abscess that was about to rupture and could already be the result of a perforated appendix, they did not know definitely until they operated.

Our tiny little girl was being so brave and the pain she must have been through would have brought any adult to their knees but she understood what was going to happen to her and that the doctors were going to take her pain away. The operation lasted well over an hour and the infection was drained and what was left of the appendix was removed. Over the next week our daughter endured a collapsed vein where the IV was put in so had to have it changed, vomiting, extreme pain when the drain was taken out of her tummy (this was put in to drain off any remaining pus).

We were discharged from hospital to continue her care and medicines at home but have been warned that it will take her a good six weeks for her to recover fully. Both the consultant and surgeon told us after the operation that we are very lucky as they got to her just in time. The nurses and doctors on the Acrewood Children’s Unit at Poole Hospital were amazing but we have been left with a bitter taste in our mouths where Salisbury Hospital and the West Hampshire out of hours service are concerned. We believe they not only missed a ruptured appendix but did not contact us to let us know that what they thought was the correct diagnosis was wrong even though we believe they knew it could not be a urinary tract infection because the tests for it were clear. I think the West Hampshire out of hours failed to make their own conclusions as to our daughters health and in my opinion did not bother to put all the evidence together to realise that our daughter was showing all the key signs of a burst or problematic appendix. I think shame on them. We now feel that we want to take this further due to our parental instincts.

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