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

## TL;DR

A patient with a large ovarian tumor and a hidden intestinal issue highlights how focusing too narrowly on obvious problems can lead to dangerous mistakes in surgery.

## Contribution

This case report illustrates the risks of surgical tunnel vision and advocates for debiasing strategies to prevent 'never events'.

## Key findings

- A massive mucinous ovarian carcinoma obscured a complicated Meckel's diverticulum during surgery.
- Tunnel vision in the presence of glaring clinical findings can lead to missed diagnoses and preventable complications.
- Debiasing strategies may help reduce cognitive biases but require further study for clinical validation.

## Abstract

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

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.

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.

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.

•Glaring clinical findings predispose to tunnel vision and consequent never events.•Systematic debiasing strategies raise awareness of never events.•Further study is needed into the value of debiasing strategies in clinical practice.

Glaring clinical findings predispose to tunnel vision and consequent never events.

Systematic debiasing strategies raise awareness of never events.

Further study is needed into the value of debiasing strategies in clinical practice.