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.
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Author: Lorenzo Alonso, MD.