Authors have retracted a case report describing a surgery to remove gallstones in a patient with Crohn’s disease after learning they’d mixed up two cases, and instead reported on a patient who had died 21 days after the procedure.
We were alerted to this story by La Repubblica, and contacted by the son of the patient (who asked not to be named, for privacy reasons). He told us he found the study and asked the journal to retract it:
…I can say that it was absolutely devastating to realise that the pictures I was looking at were from the surgery that led to the death of my father. It is something that gives me a lot of sorrow thinking that the man in that picture with the open belly was him, when he was fighting for his life. I asked the rest of my family not to see them to avoid them the same shock.
Even before the retraction appeared, we received confirmation it was coming from Giuseppe Paolisso, the Principal of the School of Medicine at the Second University of Naples, where the authors are based:
Both authors and University requested paper retraction…
Paolisso told us that the authors mixed up patients in their write-up of the study:
The original paper described a clinical case of patient that died after 21 days , despite the case report showed a successful surgical treatment (the authors have admitted to the university board to have made a mistake on reporting the clinical case with one with similar clinical conditions).
That explanation is echoed by the retraction note for “Gallstone ileus without bilioenteric fistula years after bypass surgery for Crohn’s disease. Case report and clues to etiology of a neglected cause of obstruction:”
The report has been retracted at the request of the authors. Following notification by the family of the patient covered by this case report it was discovered and confirmed by an institutional investigation that the report contained serious reporting errors including the confusion of the case with another case that was structurally different. The authors apologise sincerely to the family of the patient for the error and distress caused by the publication.
The paper has not been cited since it was published in 2015, according to Thomson Reuters Web of Science.
The patient’s son told us he found the paper while searching through the literature:
I have been interested in reading Crohn literature since I became a biochemist, although I haven’t actually worked on this topic in my lab. Indeed my father had Crohn for 40 years and there other cases in my family, so I want to keep updated on the latest treatments.
As for this paper, I was wondering on what could be the molecular origin of the Gallstones my father had, so I started searching for Gallstones and Crohn and their paper came out on pubmed.
The two cases were quite different, he added:
I discovered the publication and alerted the Editor for asking the retraction…Indeed the paper is correct in the description of the case and of the surgery, but it diverges totally from he reality in the post-operatory description. The patient actually had several post-surgery [events] and required other two desperate operations before dying (12 Oct 2014). The paper on the contrary talks of a happy ending with the patient discharged after 10 days and in good health status.
Given the differences between the two cases, he told us he finds the authors’ explanation for the case mixup “difficult to believe:”
According to the paper, the authors obtained the IRB authorisation on 4 Nov 2014 and submitted the paper on 03 Dec 2014. How is it possible that they did not realise that they were publishing the data of their patient that died less than 2 months before the [submission]?
Furthermore, he added:
They claim that two patients’ folders were confused in the archiving. The second patient was affected by Crohn but had structurally different pathology. This means that this second patient did not have the Gallstones (that are very rare), which is the topic of the publication.
How they could have confused on such a central part of the publication?
How is it possible that they confused just the happy ending? and no other data from this second patient?
Reviewing the text, there is no hint that the described patient did poorly following the procedure. Here’s a quote from the paper:
The patient recovery was uneventful, and he was discharged on postoperative day ten with parenteral nutrition support. The improved health status gradually lead to a better quality of life perception as assessed by psychiatrists.
And the last sentence of the section “Patient perspective:”
The patient is currently in good health status and would have undergone the treatment again.
That sentence is particularly upsetting, the patient’s son told us:
As for the sentence that the patient was recovering and would have taken the treatment again, this is absolutely [disrespectful] of all the sadness and void the lost of our beloved has left in us (and they know this because they were there when he died). I can never forgive them to have written this.
Even if I believe their version that this was unintentional, this story becomes even worse, as it flags they were too easy in confusing the folders of the patients. This was not a professional behaviour from them and they have not safeguarded the data of my father. This publication has generated a lot of sadness in my family and they must know that publishing data from patients is associated with a significant level of responsibility. Medical doctors should publish these data with the upmost level of rigour and control.
Finally, I must emphasise that a publication like this can be potentially harmful. If some other surgeon was treating a similar case, he/she can decide to reproduce the same operation on the bases of the miraculous results they have fraudulently published. This might harm other patients.
We’ve contacted first author Gianluca Pellino and last author Francesco Selvaggi at the Second University of Naples.
Hat tip: Fabio Turone
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First, wow, I feel bad for the son. That is a horrible thing to stumble upon.
Since they don’t let me anywhere near patients I don’t know what the protocol is for publishing case reports. Do the doctors need the patient’s (or their family’s) approval to publish the facts of their case even if the information is deidentified?