Sent home with a stomach bug.
Returned in sepsis.

Cholecystitis is acute inflammation of the gallbladder, most commonly caused by a gallstone obstructing the cystic duct. Symptoms include severe right-upper-quadrant pain, fever, nausea, vomiting, and a characteristic pain that worsens with deep breathing (Murphy sign). Untreated, cholecystitis progresses to gangrenous gallbladder, perforation, bile peritonitis, and sepsis.

The most common misdiagnosis is GERD, gastritis, or viral gastroenteritis. Other misdiagnoses include anxiety, musculoskeletal pain, kidney stone, and costochondritis. Many patients are sent home from the ER with a PPI or antiemetic prescription and return within days with sepsis. The diagnostic workup — right upper quadrant ultrasound, HIDA scan, CBC, LFTs — is inexpensive, widely available, and routinely skipped in the pattern cases.

Gangrenous cholecystitis is the progression of untreated acute cholecystitis to gallbladder wall necrosis and, ultimately, perforation. It carries a mortality rate of 15–50% in older or immunocompromised patients. Every hour of delay in diagnosis matters, and cases that progress this far almost always reflect a diagnostic failure at first presentation.

Yes, when the records support it. Emergency rooms are held to the standard of a reasonably prudent ER physician in the same community. Missing acute cholecystitis in a patient with classic right-upper-quadrant pain, fever, and elevated white blood cell count — and discharging without imaging — is a recurring pattern of malpractice. We reconstruct the exact evaluation: what was complained of, what was examined, what was ordered, and what was not.

Case value scales with the downstream harm. A delayed diagnosis that ends in an uncomplicated cholecystectomy a few days late may have limited damages. A delayed diagnosis that progresses to gangrenous gallbladder, perforation, sepsis, and ICU admission — with prolonged hospitalization, long-term recovery, and sometimes permanent disability — often settles in the hundreds of thousands to low millions. Wrongful death cases reach higher.

The Murphy sign is a physical-exam finding first described by the surgeon John Benjamin Murphy in 1903. With the patient taking a deep breath, the examiner palpates under the right costal margin. A positive Murphy sign — pain severe enough to halt the inhalation mid-breath — is highly suggestive of acute cholecystitis. Its presence does not rule in cholecystitis by itself, and its absence does not rule it out, but it is one of the four classic findings (right upper quadrant pain, fever, elevated white blood cell count, positive Murphy sign) that together should trigger a right-upper-quadrant ultrasound. When the Murphy sign is not documented and not elicited in a patient with the classic pain pattern, the chart reflects an incomplete exam.

The standard workup for suspected cholecystitis combines clinical assessment with imaging and laboratory studies. The clinical assessment is the history (classic right upper quadrant pain, often after a fatty meal, radiating to the back or right shoulder, with nausea and vomiting) plus the physical exam (Murphy sign, abdominal tenderness, fever). Laboratory studies include a complete blood count (white blood cell count typically elevated), liver function tests (mild bilirubin and alkaline phosphatase elevation possible), and lipase (to rule out pancreatitis). Right-upper-quadrant ultrasound is the first-line imaging study — gallbladder wall thickening, pericholecystic fluid, gallstones, and sonographic Murphy sign are classic findings. When ultrasound is equivocal, HIDA scan is the most specific test for acute cholecystitis and usually secures the diagnosis.

Several patient populations are statistically more likely to be misdiagnosed at first presentation. Women under forty with the classic pain pattern are often dismissed with a diagnosis of anxiety, reflux, or functional abdominal pain. Older adults and immunocompromised patients may present atypically — with confusion, generalized weakness, or minimal pain — and progress to sepsis without the textbook symptom trajectory. Patients with prior gastrointestinal diagnoses such as GERD or irritable bowel syndrome are frequently assumed to be experiencing a flare of their pre-existing condition, and the cholecystitis is missed on anchoring bias alone. Diabetic patients and those on chronic steroids can develop gangrenous cholecystitis with minimal initial symptoms, making a thorough workup essential even when the presentation seems mild.

The filing deadline depends on the state where the misdiagnosis occurred. Most states apply a statute of limitations of two to three years from the date the patient discovered — or reasonably should have discovered — that the emergency department or urgent care visit failed to diagnose the cholecystitis. A separate statute of repose, usually four to seven years from the date of the visit, caps the outside deadline regardless of discovery timing. Delayed-diagnosis cases often trigger the discovery rule because the patient does not always connect the ER visit to the subsequent sepsis or gangrenous complication until a second provider reconstructs the timeline. Minors generally receive tolling provisions. An early consultation is the fastest way to establish your specific deadline.

Liability depends on the specific failure and the chain of providers involved. The treating emergency physician or urgent-care physician is usually the primary defendant. The hospital or urgent-care facility may share liability for systems issues — understaffing, inadequate triage protocols, unavailable imaging, or delayed laboratory results. Radiologists who read an ultrasound or CT and missed findings consistent with cholecystitis can be named. Nurse practitioners and physician assistants operating under physician supervision can also be defendants when the initial evaluation was theirs. In cases where the patient was discharged despite classic findings, the attending physician who signed off on the discharge is the core defendant.

Damages track the downstream harm from the delay. Economic damages include the ICU admission that followed the eventual diagnosis, the more extensive surgery required when the gallbladder was gangrenous or perforated, the prolonged hospitalization, rehabilitation, follow-up imaging, lost wages during an extended recovery, and — in cases with permanent disability — reduced future earning capacity. Non-economic damages capture the pain and suffering of critical illness, the lasting anxiety that follows a near-death episode, and the loss of normal family and social functioning during a recovery that can stretch months or longer. In fatal cases, the survivors pursue wrongful death damages under the applicable state statute, which typically include final medical expenses, lost future earnings, and compensation for the survivors’ grief and loss of consortium.

Yes. Deaths from undiagnosed acute cholecystitis progressing to gangrene, perforation, biliary peritonitis, and sepsis are a recognized pattern in medical malpractice litigation. Every state allows eligible survivors — typically a spouse, children, and in some jurisdictions dependent parents — to bring a wrongful death claim under the state’s wrongful death statute. The elements of proof are similar to a personal injury claim (duty, breach, causation, damages) with the added requirement that the negligence caused or substantially contributed to the death. The damages framework and the categories of eligible claimants vary by state.