Cuban leader Fidel Castro is in serious condition after a series of three failed operations on his large intestine complicated by infection, the Spanish newspaper El Paisreported.
Mr Castro (80), suffered a serious infection that worsened to peritonitis, the newspaper said, citing two medical sources at the Madrid hospital where a surgeon who visited the leader in December works.
Mr Castro's prognosis is "very serious" and he is being fed intravenously, the paper said.
Cuba's President Fidel Castro pictured in a Havana hospital last August
A first operation to extract part of his large intestine and connect the colon to the rectum was a failure and the link broke, releasing faeces into the abdomen that caused another peritonitis, the newspaper reported.
A second operation to clean and drain the infected area and perform a colostomy also failed, the paper said. A third operation implanted a prosthesis, it said.
When Spanish surgeon Jose Luis Garcia Sabrido visited Mr Castro in late December, Cuban doctors were considering another operation, the paper said.
"The patient required drainage for more than half a litre of fluids a day, which is causing him a severe loss of nutrients," the paper reported.
Mr Castro, who took power in Cuba in 1959, has not been seen in public since July 26th. He handed over power to his brother five days later, fuelling speculation he is so ill he may never return to power.
In a New Year's message issued on December 30th, Mr Castro told Cubans that he was recovering slowly from surgery and said his recovery was "far from being a lost battle."
Mr Sabrido said after his visit in December that Mr Castro did not have cancer and could return to govern Cuba if he recovered fully from his surgery.