Complicated Meckel's diverticulum concealed by massive mucinous ovarian carcinoma – A case report of the cautionary tale of surgical tunnel vision

Introduction

Cognitive bias, especially tunnel vision, in the clinical setting can predispose to catastrophic outcomes termed “never events”.

Case presentation

A 58-year-old woman presented with abdominal pain on the background of chronic abdominal distension. Imaging indicated a massive ovarian lesion with presumed small bowel obstruction (SBO) secondary to mass effect. She underwent resection and staging workup. In addition to the 26.5 kg mucinous ovarian adenocarcinoma (MOC), she was intraoperatively found to have a Meckel's diverticulum (MD) with a band adhesion to proximal bowel (as the true precipitant of her SBO) and a contained enteric perforation, necessitating bowel resection and re-anastomosis. She made an excellent postoperative recovery and remains recurrence-free.

Clinical discussion

In contrast to Meckel's diverticula which pose a preoperative diagnostic challenge, the massive MOC represented a distracting synchronous pathology which predisposed to tunnel vision. Surgical tunnel vision increases the risk of never events. A variety of systematic debiasing strategies have been proposed to raise awareness of cognitive bias but further research is still necessary to investigate the long-term clinical benefit of these strategies.

Conclusion

Clinicians can readily incorporate debiasing techniques to raise awareness of unconscious biases, particularly the natural tendency to tunnel vision with glaring clinical findings. However, further study is required to explore the benefits of implementing debiasing techniques in the perioperative setting.