My husband recently underwent surgery to remove his appendix, but continued to experience vomiting, diarrhea, fever and severe abdominal pain. About a week later, his surgeon did exploratory emergency surgery, and diagnosed him with Meckel's diverticulum. Could the initial diagnosis have been wrong?

F.P.

Appendicitis is a common cause of severe abdominal pain that requires prompt medical attention. At first, the pain is typically spread widely over the abdomen, and later localizes to the lower right side. Often the patient experiences nausea, vomiting and fever. Blood tests may indicate infection, and a CT scan may confirm the diagnosis. However, because it is crucial to treat appendicitis as soon as possible, patients often undergo emergency surgery based only on the doctor's physical examination. If appendicitis is truly the cause of the symptoms, an inflamed and infected appendix will be found during surgery.

If the appendix appears normal, then another cause of the symptoms must be considered. Other possible causes include infections involving the right side of the colon, Crohn's disease, diverticulitis, and ovarian disease in women.

A much rarer cause of these symptoms is Meckel's diverticulum. This abnormality in the structure of the small intestine is found in about 2 percent of the population, and usually causes no problems. However, sometimes complications occur. The most common is intestinal ulcerations that result in maroon-colored bleeding from the rectum. Other potential complications include obstruction or infection of the intestine. In a patient with Meckel's diverticulum, obstruction can lead to the same symptoms as appendicitis, making a precise diagnosis difficult. Only after the patient is opened up for surgery can the differentiation be made.

The treatment for either diagnosis is surgical removal of the diseased section of intestine. Without reviewing the details of your husband's medical records, it is impossible to say whether the initial diagnosis was wrong in his specific case.