Looking for an answer: Gastric and small bowel dilatation

Clinical summary

The patient

Age: 77         Gender: Male

History of diseases: 1. Diabetes (several years with insulin)

2. Bladder cancer, regional, treated with chemotherapy nine months before this event, considered  complete response

Current problem: deterioration with renal insufficiency, deep venous thrombosis in his left leg with lymph nodes in the left groin, probably associated with a recurrence of the urological cancer. Episode of acute thoracic pain without coronary artery involvement. No fever. No shortness of breath. No abdominal pain. A week before, the patient started with some nausea and vomiting, but he had an active life.

Clinical evolution: improvement in kidney function after hydration.  Blood pressure going down without fever. Hemoglobin very down (Hb=6,5), needs a transfusion.  No sign of external or internal bleeding. Upper endoscopy: no ulcers, no tumor.

Finding without explanation: gastric and small bowel dilatation, without a visible mechanical obstruction or a lump.

We thought about diabetic gastroparesis, small bowel or peritoneal metastases or an abdominal ischemic problem.

Send your opinion. Thank you

Author: Lorenzo Alonso, MD.