To think I'm right and the doctors are wrong?

[Rabbitpoop]

DD is 13yo and has had really bad nausea and stomach ache for 10 days. Shes been off school the whole time and very little appetite. GP thought it was appendix related so sent us to hospital. First surgeon admitted us and said seems like appendix as she only has pain in the exact area of the appendix. Put us on the list for surgery.

Saw another surgeon who said he wanted an ultrasound first. Fair enough. They couldn't see her appendix during the scan but no obvious signs of anything else wrong so surgeon passed us to paeds.

Paediatrician came in and said it is constipation before he even examined her. She isn't constipated at all and the pain is only on the bottom right side in a specific area. I questioned him and pushed back quite a lot as I'm 100% sure this is not constipation. She's had no change in her bowel movements. Paeds said there's no sign of appendicitis in her blood tests so it's unlikely to be appendicitis.

I looked up the NICE guidelines and it says that you can't rule out appendicitis by blood test or ultrasound and that it can present differently in different people. It seems the only real way of telling is laparoscopy/surgery but the surgeons won't do it as she's not writhing in pain.

I don't know what to do. I'm sure it's not constipation and that it's something to do with her appendix. They said they wouldn't give antibiotics either as there's no sign of infection.

I'm worried they're just going to tell us to go home and she'll continue to be off school, feeling sick, barely eating and with a stomach ache.

Any advice?

Trust your gut. Read what happened to the mother in this case - her concerns were disregarded and her daughter died.

Doctors can be fallible. And worse, careless.

www.theguardian.com/society/2022/mar/04/girl-13-likely-to-have-survived-if-moved-to-intensive-care-coroner-rules

Recent experience here of appendicitis with DD13. Textbook symptoms back in the summer - couldn't see the appendix on the scan. Got dismissed with antibiotics.

Further sickness periodically up to Christmas - when she had further major pain and sickness and was admitted. If they had operated in the summer - would have been keyhole.

Ended up as open surgery as she had a gangrenous appendix and they had no idea how she was still alive with what they saw inside her plus other complications. Lots of post op infections over the following month and several further stays in hospital. Thank goodness she is fine now but she had an awful time (unnecessarily) and it cost the NHS far more than had they treated her properly in the first place.

Suggest you ask for a second opinion from the local specialist childrens hospital if you are in a general hospital (wish I had done this back in the summer)

Sending best wishes xx

GPs can be and sometimes are 100% wrong. I'd get a 2nd opinion OP. A GP once incessantly diagnosed my brother with a 'cold' even though it went on for 6 months with no cold symptoms - turns out he was simply in dire need of a heart operation I'm sure your DD will be fine but GPs are human and human error is common

Are you admitted to hospital atm?

Ds just had his appendix removed
He didn't have any of the text book symptoms
He had an uncomfortable ache (for 24 hrs ) around his belly button and
Was eating fine
But his temp and heart rate were up
And down
Gp said it was probably a urine infection so asked to see him
Said it couldn't be appendix as he wasn't in agony and he still had an appetite
After him doing some moving tests and his temp was now 39
Gp changed his mind
We were sent to hospital
Ds was still complaining he was starving and now nil by mouth
Surgeon saw him and said he's fine if he's hungry
But did bloods just incase
He came back an hour later
And said his bloods were very worrying and they were going to do a ct scan
Turns out he did have acute appendicitis and they operated within a few hours

I have experience in health care and worked alot in hospitals and variety of settings. I would urge you to say something along the lines of " the pain she is experiencing is affecting her day to day activities and she can't function normally! She needs extra help where she is normally independent and it is affecting her mood and mental health. She can't study and her appetite is reduced. I'm not leaving until I get a second opinion. I'll report you and your team for negligence and your acts of omission."

Sorry haven't read all posts just wanted to add another story of my boyfriend having appendicitis not being believed (not in enough pain). Ended up with emergency surgery appendix nearly burst. Take care OP ❤️

@Rabbitpoop

The GP said grumbling appendix but hoped it would go on its own.

Interesting to say retrocecal as that is the type that matches his symptoms according to NICE guidelines.

Sorry to be pedantic but is the 'his symptoms ' above a typo?

Obviously I don't know about your daughter's exact case, but my brother had appendicitis recently and his appendix didn't show up on ultrasound scans at all, because it was positioned behind his intestine and therefore blocked from view. Thankfully they took his symptoms to mean it was appendicitis regardless of the scan, because they managed to remove his appendix right as it ruptured. I believe retrocecal was the word they used for his case, as it took longer than normal in surgery also and he took quite a while to recover

Appendicitis is a diagnosis that looks at the history/clinical examination/ observations and blood tests.

As previous posters have said, a 10day history with normal bloods has a very low likelihood of being an appendicitis.

A large percentage of ultrasound scans don’t pick up a ‘normal’ appendix (usually size of patient’s little finger and can be hidden but if inflamed is very obvious or you would see free fluid in the abdomen/pelvis)

If she hasn’t got a fever/fast heart rate/bloods staying normal- I would agree with surgical team that this is more likely to be a mesenteric adenitis (have they had a recent cough/cold symptoms) or a medical/psychosocial cause of anxiety.

Pain at McBurney’s point may be because lots of doctors have been pressing hard on it when examining her.

If her symptoms continue, it may make sense to repeat bloods or an ultrasound scan in 2-4 weeks but I think simple pain killers and ensuring they are eating small amounts and keeping hydrated would make sense in this scenario. I would also keep a note of pain and it’s relation to periods and I’m sure it’s been done but in this day and age, I have to ask.. have they got a negative hcg test?

@Clovacloud

She’s really young but my niece had an ovarian cyst at 14, so it’s not unheard of. I think at the very least they should give your DD an ultrasound. Keep pushing for treatment, good luck.

I thought of ovarian cyst because that can present like constipation on clinical examination and vice versa, but I too thought op's daughter was a bit young for that.

Appendicitis is a very hard one to diagnose. I was in hospital 36 hours before they decided to take mine out.

Guy in bed next to me also there for same reason and they didn’t end up take his out. But they had to watch him because it could have been. I think they decided it was some kind of gastro.

One of my kids had classic symptoms of it last year. Ultrasound showed she had lymphadenitis. Which is known to mimic it.

Could it be yersiniosis which can mimic appendicitis? My son had his appendix removed because he had yersiniosis. He was sore in the side but it was the lymph node that was up rather than the appendix. Once they were in, they decided to remove his appendix. (That was really lucky for us because they found a small asymptomatic tumour in the appendix so the misdiagnosis potentially saved his life.) Apparently there is a laboratory test for yersiniosis.

I thought of ovarian cyst because that can present like constipation on clinical examination and vice versa, but I too thought op's daughter was a bit young for that

But OP has said that her DD isn't constipated - it’s the paediatrician who said she was...without examining her.

I've had a few times sent to A&E with suspected appendicitis.

First time with dd. GP examined her and sent her straight away.
She was bent double with pain and had the classic signs. That did turn out to be constipation. And I had no idea.
Second time again with dd. Turned out to be abdominal migraines brought on by anxiety.

Last time was ds. We went in at 7pm one day with stomach pain and sickness, but non-classic pain and saying pain was maximum 4/10. He was operated on the next day.
But one thing was I can see from his hospital notes that he deteriorated noticeably overnight. If she's not deteriorating, I can see why they don't want to operate.

@olympicsrock

I am a surgeon. If at 10 days into her Illness her blood tests ( WCC abs CrP) are normal this is not acute appendicitis. Ultrasound scans are often really useful in young people particularly if slim . They do not just show gynae problems but will often pick up an enlarged appendix or appendix mass/ abscess.

The appendices they do not see are the small normal ones…

Sounds like the surgeon has made a comprehensive clinical assessment.

Can I ask why the ultrasound is more useful in slim patients? I ask because a few years back I had a hysterectomy for a fibroid. By the time they operated it was the size of a 7 month pregnancy. I'm overweight and im certain if I was slim it would have been more obvious? I'm certain it was hidden in my flab

Ps i have massive respect for the NHS and unfortunately have needed their services a lot over the past year (cataracts x2, gallbladder surgery, fractured shoulder needing surgery). Personally I like their approach of not operating unnecessarily. I'm happy that the surgery and treatment I've received have been clinically needed rather than providing a way for a private surgeon to fund their new BMW.

Just in case anyone is still interested. The surgeon came back to say that their lost is full tonight so to go home and get some sleep and come back in the morning nil by mouth. So we came back in and the ward don't seem to have any idea what's going on and sent us to phlebotomy for bloods and then said we would be sent home. They didn't know anything about possible surgery. So I've asked to speak to a surgeon and they said OK but we have to go and wait in the A&E waiting room for about 5 hours. We're now in the waiting room and it's packed with people, only about half wearing masks.
She had a PCR when she was admitted yesterday. She's nil by mouth and we were expecting surgery. Now we're in a packed waiting room. Am I going crazy or does this make no sense? I'm rapidly losing faith in everyone at this hospital! Shouldn't she be isolating if she's going to have surgery?

list not lost

At 15 I was only diagnosed with appendicitis because it ruptured. I was in hospital for 4 days while they did what they are doing to your dd. They queried a cyst , constipation and my favourite that I was anxious 🤣all while I was in agony. I was rushed to surgery in the middle of the night because it burst and i became quite unwell. My parents weren't even present to give consent it was so serious.

No she won’t be isolating as she’s not ‘planned’ surgery, as in on a waiting list. Sounds like miscommunication on the surgeons part. Maybe the ward don’t have a bed right now.

Frustrating for you both though.

Unless you’ve given your consent for a diagnostic laparoscopy or appendicectomy, the nbm request would have been a precaution in case she needed to have an operation.

The emergency list works differently to elective cases when you need to isolate prior to admission (eg elective hip or knee replacement patients will be treated differently).

There seems to have been some miscommunication along the way and I hope you can find a solution that helps your daughter and that she feels better soon.

It's frustrating that we seemed to get an answer last night as the surgeon said it has been going on 10 days, now 11, with no improvement, the pain is only over the appendix, that it's worth doing the surgery.
Now we're back to square one again. She's completely fed up as had psyched herself up for surgery and now it seems as nothing has been communicated we have to go through it all again. She's only had a biscuit in 48hrs and is getting dehydrated from not being allowed to drink. The staff don't seem to know what's going on at all, which doesn't inspire confidence.

But surely it makes no sense from a covid point of view to do a PCR on admission and then make you spend hours and hours in a busy waiting room?
We were told to come in at 8am, nil by mouth, expecting surgery. Now we're sat in busy A&E.

A friend with a similar issue went to a different A and E at a nearby specialist children's hospital. They dealt with her daughter quickly and successfully.

Are you in an area where this would be possible?

I don't blame you for not trusting them when you can see the notes are wrong, and now there is no record of what's gone on. It screams incompetent.