Select location
Membership information
0800 561 9000
Medicolegal advice
0800 561 9090
Menu
Refine my search

Missed diagnosis during colonoscopy

Post date: 08/06/2021 | Time to read article: 2 mins

The information within this article was correct at the time of publishing. Last updated 07/07/2021


By Dr Sean Kavanagh

Mr Y, a 24-year-old plumber, had suffered intermittent bouts of cramping abdominal pain with associated passage of loose stools, mucus and occasional small amounts of fresh red blood, over a period of two months.

His GP, Dr D, referred him to Dr B, a consultant gastroenterologist. Dr B saw Mr Y in clinic and arranged to carry out an outpatient colonoscopy. Dr B managed to pass the scope as far as the splenic flexure, but was unable to progress any further due to difficult anatomy and the pain that the procedure was causing Mr Y. The colonoscopy was terminated. The appearance of the colonic mucosa up to the furthest point reached had been normal.

By the time of the procedure Mr Y’s symptoms had settled so Dr B reported the colonoscopic findings and the technical difficulties to Dr D, and discharged Mr Y back to his care.

Unfortunately Mr Y’s symptoms returned a few months later. He repeatedly attended Dr D’s surgery over a six-month period, with increasingly severe symptoms. Dr D treated Mr Y with PRN loperamide and diazepam as he felt that the symptoms may have been due to anxiety associated with Mr Y having recently lost his job for frequent non-attendance due to illness.

One night Mr Y woke in excruciating pain and was admitted to hospital with an acute abdomen caused by colonic perforation secondary to acute ulcerative colitis. He underwent laparotomy and repair and made a good recovery on conventional medical therapy.

Mr Y made a claim against both Drs D and B, alleging negligence in failing to make a timely diagnosis, causing him to lose his employment and endangering his life through the complications of the missed diagnosis.

Expert opinion

The Medical Protection legal team commissioned an expert in gastroenterology, who felt that Dr B had done all that could be expected of him, given the well documented technical difficulties in performing the colonoscopy, and as Mr Y was asymptomatic at the time. It was held that in this context the risk of perforation due to over-zealous passage of an obstructed colonoscope outweighed the benefits of pressing on with the procedure.

Dr B’s letter to Dr D had clearly advised that should Mr Y’s symptoms recur it would be advisable to repeat the procedure or consider other forms of investigation. On this basis we elected to defend Dr B and he was eventually dropped from the legal action. The case was settled out of court for a moderate sum on behalf of Dr D.

Learning points

  • If diagnostic investigations have to be curtailed for technical reasons, best practice dictates that clear reasons for abandoning the procedure should be documented in the medical record. 
  • It is important to consider whether alternative investigations or a repeat attempt are necessary after having to abandon an investigation. In this situation, the patient was asymptomatic, but in such a scenario, advice to the referring doctor on what to do if the problem recurs is essential.
  • GPs should have a low threshold for asking for further advice where there is an inconclusive or abandoned specialist investigation, but ongoing or worsening symptoms.






 

 
 

Share this article

Share
Load more reviews
Rating

You've already submitted a review for this item

|
New site feature tour

Introducing an improved
online experience

You'll notice a few things have changed on our website. After asking our members what they want in an online platform, we've made it easier to access our membership benefits and created a more personalised user experience.

Why not take our quick 60-second tour? We'll show you how it all works and it should only take a minute.

Take the tour Continue to site

Medicolegal advice
0800 561 9090
Membership information
0800 561 9000

Key contact details

Should you need to contact us, our phone numbers are always visible.

Personalise your search

We'll save your profession in the "I am a..." dropdown filter for next time.

Tour completed

Now you've seen all of the updated features, it's time for you to try them out.

Continue to site
Take again