A patient you consented and assisted with has sustained a colonic perforation during a therapeutic colonoscopy and requires emergency surgery. The consultant who performed it asks you to 'let them settle before we get into all that'. What do you do?

Question

A 68-year-old woman underwent an endoscopic mucosal resection this morning. A perforation was recognised at the time and she is now on the emergency theatre list. Her husband is in the waiting room and has been told only that 'there were some difficulties'.

Accepted Answer

My first responsibility is to the patient's immediate care, so I would make sure the surgical referral, resuscitation, antibiotics and theatre preparation are all in hand. Once she is safe, the candour obligation is not something that can be deferred. A recognised perforation requiring emergency surgery is at least moderate harm, which triggers the statutory duty of candour, and that duty requires that she and, with her consent, her husband are told what happened, given an apology, told what it means and what will be done, and that this is followed up in writing. I would speak to the consultant directly and privately rather than around him. I would assume he is anxious rather than obstructive, and I would say two things: that this is a statutory requirement rather than a judgement call about timing, and that an apology is not an admission of legal liability — NHS Resolution is explicit about that, and families who are told early are consistently less likely to litigate, not more. I would offer to be present for the conversation, or to have it together, which usually resolves this. If he still declined, I would not let it drop. I would escalate to the clinical director and inform my own consultant, and the Freedom to Speak Up Guardian is available if I needed it. Practically, the husband should not be left with 'some difficulties' while she is in theatre; he needs an honest account now. Alongside this I would complete a Datix, expecting a proportionate learning response under PSIRF, document the timeline factually in the notes without speculation about cause, and make sure the endoscopy governance lead is aware so the case reaches the unit's morbidity meeting.

Duty of Candour After an Endoscopic Perforation

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