Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

A surgeon mistakes a kidney for a tumor. How can this happen?

Skeptical Scalpel, MD
Conditions
December 3, 2018
Share
Tweet
Share

A number of media outlets recently featured a story about a Florida general surgeon who removed a normal kidney from a woman who was undergoing spine surgery. How could this have occurred?

The 51-year-old patient who had been injured in a car crash was scheduled for an anterior lumbar interbody fusion (ALIF) of the fifth lumbar to the first sacral vertebra. The general surgeon’s role was to provide exposure for the spine surgeons by making an incision in the lower abdomen and moving the intact peritoneum and its contents aside so the spine could be visualized.

In the process, the general surgeon encountered a mass, which he thought was a malignant tumor, and removed it completely. The ALIF procedure went on as planned. When the pathology report came back “normal kidney,” a review of the patient’s two preoperative MRI studies showed the patient had a pelvic kidney. None of the many articles about this case said whether the presence of the pelvic kidney had been reported by the radiologists, but since radiologists were apparently not sued, they must have mentioned the ectopic kidney.

The illustrations below show the typical appearance of a left pelvic kidney. The green ellipse shows the right kidney in its normal position, and the red outlines the ectopic left kidney in the iliac fossa. If this was the anatomy the patient had, the kidney would have been sitting right in front of the L5-S1 disk space. A pelvic kidney, one of a number of renal anomalies, occurs in about 1 in 500 to 3,000 individuals.

An informal and unscientific Twitter poll found that 77% of 131 responding general surgeons who assist on ALIFs said they review the patient’s imaging themselves. Had I encountered an unexpected mass in the operative field while exposing the spine, I would have immediately looked at the patient’s MRIs to determine if a mass was present and what the radiologist thought it was.

The 2016 case resulted in a lawsuit that was settled. The patient received $250,000 from each of the two orthopedic spine surgeons’ malpractice insurance carriers, and according to his lawyer, a “nominal amount” from the general surgeon who, by the way, did not have malpractice insurance. None of the articles mentioned any contribution to the settlement by the hospital, although the general surgeon’s defense was that the hospital failed to inform him that the patient had a pelvic kidney [not a good excuse].

Florida allows physicians to practice without malpractice insurance, and many of those who have insurance, carry limits of $250,000 per occurrence and $750,000 per year. Physicians in most states choose policies with limits of $1 million/$3 million. As of 2014, yearly malpractice premiums for general surgeons in Florida ranged from $57,000 to $190,000 per year depending on location, risk profile, and other factors.

What happens to a patient who has only one kidney? Many people are either born with one kidney, lose a kidney due to injury or disease, or donate a kidney. Most of them fare well, but one study showed that donating a kidney may reduce one’s life expectancy by 1/2 to 1 year.

The general surgeon is not out of the woods yet. The Florida Department of Health has filed a complaint, stating “Respondent performed a medically unnecessary procedure on [the patient] by removing a pelvic kidney during a lumbar fusion.” Possible penalties include remedial education, a fine, probation, restriction of practice, and suspension or permanent revocation of his license.

Surgeons, if you are going to help a spine surgeon, you would be wise to review the images before surgery and familiarize yourself with the possible locations of a pelvic kidney.

“Skeptical Scalpel” is a surgeon who blogs at his self-titled site, Skeptical Scalpel.  This article originally appeared in Physician’s Weekly.

Image credit: Shutterstock.com

Prev

Chill out. Doctor’s orders.

December 2, 2018 Kevin 0
…
Next

What this physician learned by helping a medical student write a personal statement

December 3, 2018 Kevin 2
…

ADVERTISEMENT

Tagged as: Nephrology, Surgery

Post navigation

< Previous Post
Chill out. Doctor’s orders.
Next Post >
What this physician learned by helping a medical student write a personal statement

ADVERTISEMENT

More by Skeptical Scalpel, MD

  • The hospital CEO who made a surgical incision. What happened?

    Skeptical Scalpel, MD
  • Medical error is not the third leading cause of death

    Skeptical Scalpel, MD
  • Should speed-eating contests be banned?

    Skeptical Scalpel, MD

Related Posts

  • Medical bankruptcies happen less frequently than you think

    Peter Ubel, MD
  • Why creative endeavors are important for the future surgeon

    Thomas L. Amburn
  • For change to happen, humbly look at ourselves

    Gabriella Gonzales, MD and Alexander Rakowsky, MD
  • HIPAA case studies: misguided mistakes and egregious errors

    Michael J. Sacopulos, JD
  • Including the patient perspective on tumor boards

    Don S. Dizon, MD
  • Paging the surgeon general: America needs you

    Linda Girgis, MD

More in Conditions

  • Why telling kids to eat less and move more fails to address obesity

    Callia Georgoulis
  • Clinical ghosts and why they haunt our exam rooms

    Kara Wada, MD
  • High blood pressure’s hidden impact on kidney health in older adults

    Edmond Kubi Appiah, MPH
  • How declining MMR vaccination rates put future generations at risk

    Ambika Sharma, Onyi Oligbo, and Katrina Green, MD
  • How one unforgettable ER patient taught a nurse about resilience

    Kristen Cline, BSN, RN
  • Why regular exercise is the best prescription for lifelong health

    George F. Smith, MD
  • Most Popular

  • Past Week

    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why so many doctors secretly feel like imposters

      Ryan Nadelson, MD | Physician
    • High blood pressure’s hidden impact on kidney health in older adults

      Edmond Kubi Appiah, MPH | Conditions
    • The physician who turned burnout into a mission for change

      Jessie Mahoney, MD | Physician
    • Why more doctors are leaving clinical practice and how it helps health care

      Arlen Meyers, MD, MBA | Physician
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • The hidden cost of professionalism in medical training

      Hannah Wulk | Education
    • The cost of ending shadowing in medical education

      Matthew Ryan, MD, PhD | Education
    • Why hospital jobs are failing physicians: burnout, pay, and lost autonomy

      Justin Nabity, CFP | Finance
    • Why so many doctors secretly feel like imposters

      Ryan Nadelson, MD | Physician
    • Why telling kids to eat less and move more fails to address obesity

      Callia Georgoulis | Conditions
    • Why enterprise risk management is key to value-based health care success

      Olumuyiwa Bamgbade, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 7 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why so many doctors secretly feel like imposters

      Ryan Nadelson, MD | Physician
    • High blood pressure’s hidden impact on kidney health in older adults

      Edmond Kubi Appiah, MPH | Conditions
    • The physician who turned burnout into a mission for change

      Jessie Mahoney, MD | Physician
    • Why more doctors are leaving clinical practice and how it helps health care

      Arlen Meyers, MD, MBA | Physician
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • The hidden cost of professionalism in medical training

      Hannah Wulk | Education
    • The cost of ending shadowing in medical education

      Matthew Ryan, MD, PhD | Education
    • Why hospital jobs are failing physicians: burnout, pay, and lost autonomy

      Justin Nabity, CFP | Finance
    • Why so many doctors secretly feel like imposters

      Ryan Nadelson, MD | Physician
    • Why telling kids to eat less and move more fails to address obesity

      Callia Georgoulis | Conditions
    • Why enterprise risk management is key to value-based health care success

      Olumuyiwa Bamgbade, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

A surgeon mistakes a kidney for a tumor. How can this happen?
7 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...