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this case serves as a reminder
of the importance of taking a
detailed history and thoroughly
investigating all angles
M
r a, a retired Mr B’s bowel habit wasn’t
electrician, went altered. an abdominal
to see his gp, dr examination was recorded
f. recently his cousin had as normal. no rectal
been diagnosed with a rare, examination was performed.
inherited haematological three months after this,
condition and he wanted Mr a suffered constipation
to know if he had it too. as and requested a laxative. a
part of the work-up, dr f prescription was issued and
requested a full blood count he was asked to attend the
(fBc) and serum ferritin. surgery. He saw a partner
the tests showed that who, noting a five-month
Mr a hadn’t inherited the history of abdominal pain and
condition, but revealed the previous positive foBs and
borderline anaemia, with anaemia, requested an urgent
a significantly low serum surgical outpatient opinion.
ferritin. the anaemia Before he was seen, Mr a
was not investigated, was admitted to hospital as
nor were arrangements an emergency, with intestinal
made to follow it up. obstruction. He was found
six months later, Mr a to have a large, stenosing even clearer when the deficiency anaemia, which
had a private medical- adenocarcinoma of the foBs became available. can be found here on their
screening examination. sigmoid-colon, which had dr o’s failure to relate the website: www.bsg.org.uk.
a further fBc showed metastasised to his liver. abdominal pain to the nice has produced referral
persistent anaemia. a faecal He died within a year previous laboratory findings guidelines for suspected
occult blood (foB) test of being diagnosed. was similarly criticised. cancer, available on their
was strongly positive. this a claim alleging negligent surgical opinion was that website: www.nice.org.uk.
information was forwarded investigation of Mr a’s test had Mr a been diagnosed the guidance is due to be
to dr f. she repeated the results and clinical complaints when he was found to be reviewed in June 2010.
fBc and haematinics, by drs f and o, was anaemic, his chances of
finding Hb just inside the brought by Mr a’s family. survival would have been
normal range. serum greater, as metastasis case reports
ferritin remained grossly was unlikely to have
depleted. dr f suspected expert opinion occurred at this stage. MPS publishes
this was due to a bleeding the claim was settled. medicolegal reports as
intestinal polyp and initiated expert gp opinion was an educational aid to
no further investigation. critical of dr f. “the correct members and to act
two months passed response to the blood test further reading as a risk-management
and Mr a saw dr f again, results was … to carry out tool. The reports are
complaining of epigastric a detailed history in regard unexplained iron- based on issues arising
pain, which dr f attributed to diet and gastrointestinal deficiency anaemia requires in MPS cases from
to dyspepsia due to stress. complaints, conduct an investigation. the British around the world. Facts
Mr a’s pain persisted , examination and almost society of gastroenterology have been altered to
so he saw a locum gp, dr certainly to consider bowel has published guidelines preserve confidentiality.
o, who documented that investigation.” this was for the management of iron
12 sessional gp | voluMe 1 | 2009 www.mps.org.uk
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