Fidel Castro himself told surgeons not to perform a colostomy, opting instead for a course of surgery that produced a complication leaving the Cuban leader in far worse condition, according to a newspaper report Wednesday.
After removing an inflamed piece of Castro's large intestine in an operation last year, the doctors connected the remainder directly to his rectum, rather than attaching a colostomy bag, El Pais said, quoting two medical sources at Madrid's Gregorio Maranon hospital. The operation failed when a suture burst.
"The Cuban dictator and his advisers are the ones who decided on the surgical technique that has led to the complications," the paper said.
While the newspaper article did not name the sources, one of the journalists who wrote it told The Associated Press that both were doctors at the hospital. The journalist, Oriel Guell, said none of the information in articles published Tuesday and Wednesday came from surgeon Jose Luis Garcia Sabrido, who flew to Cuba in December to treat the 80-year-old Castro.
Garcia Sabrido, the hospital's chief surgeon, declined comment Wednesday but said in an interview posted on a cable news network's Web site that El Pais' account of Castro's condition being grave was wrong.
"According to my information, there is even some progressive improvement," Sabrido was quoted as saying. "The only truthful parts of the newspaper's reports are the name of the patient, that he has been operated on, and that he has had complications. The rest is rumors."
He provided no new details about Castro's health.
A Cuban diplomat in Madrid said Tuesday that the newspaper's report was "an invented story."
"It's another lie and we are not going to talk about it. If anyone has to talk about Castro's illness, it's Havana," said the diplomat, who spoke on condition of anonymity in line with normal diplomatic practice.
Experts say it's possible Castro and his surgeons went for the riskier procedure to spare him the indignity of being temporarily attached to a colostomy bag for waste removal. In standard colostomies, patients are dependent on such bags for approximately six weeks.
Attempting to reattach the colon to the rectum is an inherently trickier surgical procedure, since waste can leak into the abdomen, causing infection.
"It sounds like they took a gamble and they lost," said Dr. Peter Shamanian, an associate professor of surgery at New York University School of Medicine, referring to Castro's surgeons.
Though Shamanian said it was difficult to speculate on Castro's condition, he said colostomies are a standard procedure that do not usually result in serious complications.
Venezuelan President Hugo Chavez, a close friend of Castro, said Wednesday that the report of Castro being near death was speculation, but did not elaborate.
"About 10 days ago he called me and we spoke for about half an hour," Chavez said during a speech in the Venezuelan capital.
Chavez said he was breaking a promise by talking about the conversation because Castro allegedly said to him: "I beg you please don't tell anyone that I called you because then they get jealous, and others call me from I don't know where and want to speak with me, but I'm hardly calling anyone."
The Venezuelan president gave no further details on their conversation or on Castro's progress other than reiterating earlier comments the situation was "delicate" and that his recovery was a "slow" and not free from risks."
El Pais reported Tuesday that Castro is in "very grave" condition after three failed operations and complications from the intestinal infection diverticulitis.
El Pais said that in December, when Garcia Sabrido visited, Castro had an abdominal wound that was leaking more than a pint of fluids a day, causing "a severe loss of nutrients." The Cuban leader was being fed intravenously, the report said.
Cuba has released little information on Castro's condition since he temporarily ceded power in July to his brother, Defense Minister Raul Castro, until he could recover from emergency intestinal surgery, prompting much speculation and rumor in the country and around the world.
Washington had speculated that Castro could suffer from cancer — a supposition denied by Garcia Sabrido. Some U.S. doctors believed Castro was suffering from diverticular disease, which can cause bleeding in the lower intestine, especially in people over 60. In severe cases, emergency surgery may be required.