§ GUIDE · MISSED APPENDICITIS

Sent home with a stomach bug,
back with a burst appendix.

Abdominal pain is one of the most common reasons to be sent home from A&E and one of the hardest to judge. The courts do not expect every appendix to be diagnosed on the first visit. They ask whether the signs that were there were acted on, how long the delay was, and what the delay added to the harm.

Judgments read

7

Claimant succeeded

4 of 7

Williams: the delay

Hours, not days

Macaulay: the outcome

Lower leg lost

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§ BEFORE YOU GO FURTHER

For a missed appendicitis claim to get anywhere, these things usually need to be true

  • You attended A&E, a GP or 111 with abdominal pain and were sent home or kept waiting, and a ruptured appendix, perforated bowel, abscess or peritonitis was found later.
  • There were signs that should have prompted investigation: a high pain score, fever, raised inflammatory markers, a guarded abdomen, a child who could not keep fluids down.
  • The delay changed the outcome: a rupture that would have been avoided, sepsis, a stoma, further operations, intensive care, or in the worst cases a death.
  • It happened within the last three years, or you only recently learned that care fell short.

Brady is the warning. The judge accepted that an earlier biopsy would have avoided the harm and still found the doctors were not negligent in not doing one. Hindsight is not the test.

§ 01

Hours matter: the Privy Council on delay.

Williams v The Bermuda Hospitals Board [2016] UKPC 4 is the case solicitors reach for when a delay made an infection worse. A patient with appendicitis waited hours for a CT scan and surgery. By the time his appendix was removed it had ruptured, and the sepsis that followed damaged his heart and lungs.

The hospital argued that some of the harm would have happened anyway. The Privy Council held it liable because its delay had materially contributed to the injury: the claimant did not have to prove the whole injury would have been avoided, only that the delay made a more-than-negligible contribution. The decision is persuasive rather than binding in England and Wales, and it is relied on constantly in sepsis and delayed-treatment claims.

§ 02

Left before the plan was made.

Macaulay v Karim [2017] EWHC 1795 (QB)

A 53-year-old diabetic attended A&E with fever, rectal pain and difficulty passing urine. A possible abscess was noted, but he left before his blood results came back and was not properly investigated. He returned two days later in septic shock and lost his lower leg, toes and fingers. The court found that proper care at the first attendance would have avoided the amputations. The separate claim against his GP failed.

Somoye v North West Anglia [2023] EWHC 191 (KB)

Dr Somoye died of abdominal sepsis and multi-organ failure a week after gynaecological surgery. The trust's own investigation found failures to act on signs of infection and to follow the sepsis pathway, and it admitted liability before proceedings. When it later tried to withdraw that admission the court refused and entered judgment for her husband.

MJF v University Hospitals Birmingham [2024] EWHC 3156 (KB)

A young woman had a feeding tube inserted and was found unresponsive two days later with peritonitis and sepsis. The judge rejected the doctor's account of how the tube was fixed and found it had been placed under too much tension. Judgment for the claimant, with causation limited in part.

§ 03

When the court found no negligence.

Brady v Southend University Hospital [2020] EWHC 158 (QB)

After an appendectomy a woman developed an abdominal mass that scans labelled a harmless omental infarction. It was in fact a rare bacterial infection that later formed an abscess needing surgery. Damages had been agreed at £56,000 if she won. The judge accepted an early biopsy would have avoided this and still held the doctors were not negligent in not doing one.

Deakin-Stephenson v Behar [2024] EWHC 2338 (KB)

Admitted with perforated diverticulitis, the claimant had a keyhole washout, deteriorated 36 hours later and needed an emergency operation leaving her with a stoma. She said she had asked for a colorectal referral and was not properly consented. The judge found none of it proved and dismissed the claims against the surgeon and the trust.

Saunders v Central Manchester University Hospitals [2018] EWHC 343 (QB)

Five days after bowel surgery the claimant developed sepsis and lost his whole colon. He alleged the surgeon had damaged an artery. The judge was not satisfied the injury was caused by negligence rather than a naturally occurring clot.

§ 04

What the test actually is.

The first visit is judged by what a competent clinician would have done with the presentation that day, not by what the operation later found. Abdominal pain that turns out to be appendicitis is not negligence if the examination was reasonable, the observations were normal and sensible advice to return was given. It becomes negligence when signs that were recorded, or should have been, were not followed up: a high pain score, a temperature, abnormal bloods, a possible abscess noted and then nobody waiting for the results.

Causation is often the easier half in these claims, because Williams allows a claimant to succeed where the delay made a developing infection worse without having to prove every bit of harm would have been avoided. It is the breach, the question of whether anything should have been done differently on the day, that decides most of them, and Brady shows how hard that can be.

Children are a special case. Appendicitis in young children often presents atypically, and the court will look at whether the child was examined, whether fluids were kept down, and what the parents were told about coming back.

§ 05

What helps a claim.

  • Triage notes, observations and the pain score as recorded, which fix what the department knew.
  • Blood results from the first visit, and whether anyone reviewed them before you left.
  • The discharge advice, and whether it was written down.
  • The timing of your return and what the operation found: a perforated or gangrenous appendix, an abscess, peritonitis.
  • Intensive care records if you were admitted there.
  • Any investigation the trust carried out itself, which in Somoye was decisive.

§ THE JUDGMENTS BEHIND THIS GUIDE

The seven judgments behind this guide.

Four claimants succeeded and three did not. Read the losses first: they are where most abdominal pain claims end.

Claimant succeeded

Williams v The Bermuda Hospitals Board

[2016] UKPC 4·2016·Appeal decision

A patient with appendicitis waited hours for a CT scan and surgery; by the time his appendix was removed it had ruptured and sepsis had damaged his heart and lungs. The Privy Council held the hospital was liable because its delay materially contributed to the injury, even though some harm would have occurred anyway.

Where negligent delay makes an existing condition worse in a cumulative way, a claimant need not prove the whole injury would have been avoided, only that the delay made a more-than-negligible contribution. This is often relied on in sepsis and delayed-treatment claims.

Claimant succeeded

Macaulay v Karim & Anor

[2017] EWHC 1795 (QB)·2017·Liability decided at trial

A 53-year-old diabetic attended A&E with fever, rectal pain and urinary difficulty; a possible abscess was noted but he left before blood results and was not properly investigated. He returned two days later in septic shock and lost his lower leg, toes and fingers; the court found that proper care at the first attendance would have avoided the amputations.

Diabetic patients with fever and localised pain need prompt investigation for a source of infection. A&E is responsible for ensuring a possibly septic patient is not allowed to leave without a plan.

Claimant succeeded

Gbolahan O Somoye v North West Anglia NHS Foundation Trust

[2023] EWHC 191 (KB)·2023·Liability decided at trial

Dr Somoye died of abdominal sepsis and multi-organ failure a week after a myomectomy; the trust's own root cause analysis found failures to act on signs of infection and to follow the sepsis pathway, and it admitted liability before proceedings. The court refused to let the trust withdraw that admission and entered judgment for her husband, with damages to be assessed.

A pre-action admission of liability is binding unless the court permits withdrawal, and later-obtained expert evidence will not usually justify that. Failing to follow a hospital sepsis pathway is a recognised basis for a claim.

Claimant succeeded

MJF v University Hospitals Birmingham NHS Foundation Trust

[2024] EWHC 3156 (KB)·2024·Liability decided at trial

A young woman with cerebral palsy had a PEG feeding tube inserted and was found unresponsive two days later with peritonitis and sepsis. The judge rejected the doctor's account of how the tube was fixed, found it was placed under too much tension, and entered judgment for the claimant.

Where a clinician's recollection is unreliable and contradicted by the physical evidence, the court can find a procedure was done negligently. Causation may still be limited where a pre-existing condition would have deteriorated anyway.

Claim failed

Brady v Southend University Hospital NHS Foundation Trust

[2020] EWHC 158 (QB)·2020·Liability decided at trial

After an appendectomy a woman developed an abdominal mass that scans labelled a harmless omental infarction; it was actually a rare bacterial infection that later formed an abscess needing surgery. The judge accepted an early biopsy would have avoided this but held the doctors were not negligent in not doing one.

Hindsight showing that a test would have helped is not the same as proving it was negligent not to do it. Unusual infections that mimic benign findings on scans are a recognised trap for both clinicians and claimants.

Claim failed

Philippa Caroline Deakin-Stephenson v Nebil Behar and Chelsea and Westminster Hospital NHS Foundation Trust

[2024] EWHC 2338 (KB)·2024·Liability decided at trial

Admitted with perforated diverticulitis, the claimant had a laparoscopic washout and deteriorated about 36 hours later, needing an emergency Hartmann's procedure with a stoma and intensive care. She alleged she had asked for a colorectal referral, was improperly moved to private care and was not properly consented, but the judge found none of this proved and dismissed the claims against both the surgeon and the trust.

Consent disputes turn on evidence of what was actually discussed; where the records and the surgeon's account show the alternative procedure was explained, a claim based on inadequate consent is likely to fail.

Claim failed

David John Saunders v Central Manchester University Hospitals NHS Foundation Trust

[2018] EWHC 343 (QB)·2018·Liability decided at trial

Five days after surgery to reverse his ileostomy the 60-year-old claimant developed sepsis and his whole colon had to be removed because its blood supply had failed. He alleged the surgeon had damaged the marginal artery, but Yip J was not satisfied that the injury was caused by negligence rather than a naturally occurring clot.

A serious complication after bowel surgery is not itself proof of negligence; the claimant must show on the balance of probabilities that a surgical error, rather than an unavoidable event, caused the harm.

Browse the whole case library →

Contains information licensed under the Open Justice - Licence v2.0. Judgments from Find Case Law, The National Archives. Summaries are ours; amounts only where printed in the judgment.

§ QUESTIONS

Common questions

Is being sent home with appendicitis negligence?

Not by itself. The court asks whether the examination, observations and advice on the day were what a competent clinician would have provided. It becomes negligence when signs that were there, or should have been looked for, were not acted on. Macaulay v Karim is an example of signs noted and then not followed through.

My appendix burst while I was waiting in hospital. Is the delay a claim?

It can be. In Williams v The Bermuda Hospitals Board a delay of hours before CT and surgery led to rupture and sepsis, and the hospital was liable because the delay materially contributed to the damage, even though some harm would have occurred anyway.

The hospital's own investigation admitted failings. Does that settle it?

It helps a great deal. In Somoye v North West Anglia the trust's root cause analysis found failures and it admitted liability; the court refused to let it withdraw that admission. An admission of breach still leaves the question of what the breach caused, but it removes the hardest argument.

The scan was reported as clear. Can that be negligence?

Only if a competent radiologist would have reported it differently, or a competent clinician would have investigated further despite the report. Brady v Southend shows a scan honestly reporting a benign appearance that turned out to be an infection, with no negligence found.

What does 'material contribution' mean?

Where a negligent delay makes an existing condition worse in a cumulative way, the claimant need not prove the whole injury would have been avoided, only that the delay made a more-than-negligible contribution. It comes from Williams v The Bermuda Hospitals Board and is relied on in sepsis claims.

How long do I have to claim?

Usually three years from the treatment or from when you first knew something had gone wrong. For a child the three years run from their eighteenth birthday. Complaining to the hospital does not pause the clock.

§ MORE GUIDES

Plain answers to the other questions people ask.

Why claims fail →

Eleven real judgments where the claim failed, and what each one teaches about proving breach of duty, causation and loss in a medical negligence claim.

Antibiotic delay claims →

How courts judge delays in giving antibiotics for sepsis and meningitis: the causation battle, material contribution, and admissions of liability.

Sent home from A&E →

A&E discharge claims: the duty that starts at the reception desk, missed warning signs, and the causation hurdle that decides most cases. Real judgments.

Child sent home →

Six published judgments on children discharged or reassured with meningitis, sepsis, asthma or infection. Four succeeded, one at £9.3 million.

Severe infection missed →

Seven published judgments on necrotising fasciitis, abscesses and post-operative infections that were missed or treated late. Three succeeded. Why four failed.

NHS payout data →

Official NHS Resolution figures, band by band, for 2024/25.

This guide is general information about the law in England and Wales, not legal advice about your case. ClaimGavel is run by Costart Projects Ltd on behalf of Tomlin & Partners, a specialist medical negligence firm regulated by the SRA. The free assessment on this page is an AI overview to show you roughly where you stand; a solicitor confirms the position in a free, no-obligation conversation.