Mr Q, a 23-year-old student, was admitted to hospital as a surgical emergency with an acute abdomen. A provisional diagnosis of acute appendicitis was made and Mr S, consultant surgeon, performed a laparoscopic procedure. The findings at the time of surgery revealed a normal appendix, which was removed.
Mr S undertook a thorough inspection of the rest of the abdominal contents and discovered a small perforation of the body of the stomach with thickening of the surrounding tissue and localised contamination. A biopsy of the perforation site was taken and sent to the pathology laboratory for frozen section analysis by consultant pathologist Dr F.
Dr F called the operating theatre a short time later to discuss the biopsy result, which appeared to demonstrate an undifferentiated malignant tumour. Both Mr S and Dr F considered this to be highly unusual, particularly in view of Mr Q’s age. Dr F was confident in the accuracy of his initial assessment of the specimen, but felt that further histopathological analysis and stains together with a second opinion from colleagues in his department would be helpful. Following this discussion, Mr S decided at this point simply to close the perforation with an omental patch, wash out the contaminated fluid and await further assessment of the biopsy.
Many doctors will have a claim made against them during their professional lives
Postoperatively, Mr Q made a straightforward recovery. Mr S requested a CT scan that did not reveal any other disease and only demonstrated some gastric wall thickening at the site of the perforation. After further histopathology tests, the final opinion of Dr F and his colleagues was that the initial diagnosis of an undifferentiated malignant tumour was correct. Following careful discussion between Mr S and the patient, Mr Q underwent a total gastrectomy three days after the initial biopsy. Again, Mr Q made an uneventful recovery. The final pathology report from the resected specimen proved to be a normal stomach with no features of malignancy.
On the grounds that his major surgery had been unnecessary, Mr Q made a claim against the doctors involved in his care. The hospital initiated an internal investigation and it became apparent that there had been an error in the pathology laboratory. The frozen section sample taken from Mr Q had been mislabelled in the pathology department and actually belonged to another patient who had had surgery some hours earlier. The correct specimen taken from Mr Q was entirely benign.
The case was defended successfully on behalf of the member, Mr S. An investigation by the regulatory body (to whom the clinicians involved had been reported) also exonerated Mr S and Dr F. A separate claim against the hospital did, however, result in a substantial settlement for the claimant on the basis of errors in the pathology labelling processes.
This is a genuine case from outside the UK, and was reported in the media.