An abdominal pain case that began as suspected appendicitis eventually evolved into a medico-legal dispute centred not on how surgery was performed, but on whether it should have been performed at all.
The patient had approached the hospital with acute stomach pain and underwent investigations including ultrasound examination. Based on the findings, doctors advised surgery for acute appendicitis, and an appendectomy was performed. Despite the operation, however, the patient continued to experience pain and discomfort during admission.
When symptoms persisted, the patient sought treatment elsewhere.
Further investigations at higher centres reportedly revealed that the patient was not suffering from acute appendicitis. Instead, he was found to have intestinal perforation and other abdominal complications requiring extensive corrective procedures, including exploratory laparotomy, lavage, ileostomy, and later restorative surgery.
The patient alleged that he had undergone an unnecessary appendectomy due to negligent diagnosis and incomplete evaluation before surgery.
The hospital defended the treatment by arguing that the surgery had been conducted by a competent surgeon after ultrasound findings supported appendicitis. It also contended that the patient had not produced expert evidence proving negligence.
But the Commission focused on one striking detail in the medical record.
The original ultrasound report had indeed referred to acute appendicitis — but with a question mark beside the finding. More importantly, the sonologist had specifically advised a CT abdomen for confirmation.
That recommendation became pivotal.
The hospital failed to produce any material showing that the advised CT scan was ever conducted before proceeding to surgery. In the Commission’s view, once the imaging itself expressed diagnostic uncertainty and recommended further evaluation, moving directly to appendectomy without completing the suggested work-up amounted to a departure from reasonable medical caution.
The District Commission awarded compensation, and the appellate Commission affirmed the finding.
The ruling underscores a recurring medico-legal principle in surgical practice: where diagnostic reports themselves indicate uncertainty, the duty of care may require further confirmation before invasive intervention is undertaken. In such cases, the missing investigation can become more legally significant than the surgery itself.
IML Insight
Diagnostic uncertainty is not negligence. Ignoring documented uncertainty can become negligence.
Radiology and imaging reports often contain qualifying language such as “suggestive of,” “likely,” or “?” to indicate provisional findings. When further evaluation is expressly advised, proceeding to surgery without completing that diagnostic pathway may later expose clinicians and hospitals to allegations of premature intervention.
The case highlights how medico-legal scrutiny frequently turns not only on what treatment was given, but on whether enough diagnostic caution preceded it.
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