We received a case report describing the diagnosis and treatment of a middle-aged woman who presented to a gastroenterology service in England with weight loss and a right iliac fossa mass. The authors did a barium swallow, duodenal and gastric biopsies, and diagnosed Crohn’s disease by the radiological appearances on follow-through. They did not do a colonoscopy, or biopsy the mass in the terminal ileum. They treated the patient with immunosuppression, and she came back four times over the following year with no improvement, and died of small-bowel obstruction due to her leiomyosarcoma. The editor who received this case report telephoned the corresponding author to ask if he wished to resubmit it to the section on medical error, but he did not feel that the case indicated any error on their part. The editor then sent the case for peer review, and the reviewer pointed out that it was standard care in his country (Australia) to do a colonoscopy and biopsy a tumour before diagnosing Crohn’s disease, and that in the developing world, tuberculosis of the terminal ileum was a more likely diagnosis, one that the authors hadn’t considered. The file was discussed at the editorial meeting, and the editors decided to reject the case report, but felt that their duty as doctors had not been adequately fulfilled, but were unsure as to how to proceed. What should they do now?
The editor should contact the institution and request an investigation. The editor should inform the authors of the editor’s intention to contact the institution.
We contacted the Medical Director of the Hospital (with the knowledge of the author) and he undertook an investigation. This investigation revealed that the corresponding author had in fact never seen this patient and omitted the important information that the patient had refused invasive diagnosis and was therefore managed in the way as described.