Risk of Delayed Diagnosis of Colorectal Cancer in Patients With Gallstone Disease

Abstract

Hypothesis. Gallstone disease increases slightly the risk for colorectal cancer. This association could lead to omission of the diagnosis of colorectal cancer in patients with gallstones in the situation of mistaken interpretation of clinical data and premature closure of diagnosis.

Materials and methods. A retrospective study including 693 patients operated by the same surgeon over a period of 15 years was performed. Patients who already had cholecystectomy (56) and those in whom the cholecystectomy was performed no more than 2 years before the diagnosis of colorectal cancer (9) were identified. For the latter 9 patients the chronological relationship between the onset of symptoms, the moment of cholecystectomy and the moment of diagnosis of colorectal cancer was assessed. Patients in whom colorectal cancer could have been diagnosed in the moment when the gallstone disease was treated were identified. The cognitive mechanisms of possible diagnostic errors were analyzed.

Results. In 7 patients the colorectal tumor could have been diagnosed at the moment of cholecystectomy; 4 patients had also symptoms that were not related to the gallstones. The omission of the diagnosis of colorectal cancer was related to the superficial/incomplete patient examination (4 cases), premature closure of diagnosis (3 cases), confirmation errors (1) and heuristic failure (1).

Conclusions. Missing the diagnosis of colorectal cancer in gallstone patients is infrequent, but when it appears it determines a delay in the treatment of neoplastic disease. The error is due to premature closure of diagnosis, misinterpretation of symptoms or incomplete patient examination.