CASE REPORT 1
A 28 years old patient attended to our hospital with severe lower abdominal pain of both iliac fossae and hypogastria.
There was some degree of tenderness. She was able to pass urine and stool.
HVS showed aspecific infection like bacterial vaginosis, PT was negative, U/S showed multiple masses at both adnexa. Masses were looking solid and with complex parenchyma.
There was mild effusion of fluid in the Douglas.
Liver, pancreas and spleen were regular. Kidneys normal.
PAST MEDICAL HISTORY
Nothing really important if not the fact that she had been treated in the past for PUD.
At present no signs of PUD.
U/S was interpreted as for of PID.
She was put on antibiotics (ROCEPHIN) and actually she improved for a while.
She reported to the hospital again 10 days later with severe abdominal pains and some degree of abdominal distension.
At U/S the masses were enlarged in shape and size, but ascites was more.
I decided to refer the patient to another hospital for surgeon’s opinion.
She was admitted for few days and discharged with a 2nd cause of treatment for PID.
Condition worsened and she started vomiting terribly; she became anorexic and wasted.
I then decided on CT scan of the abdomen.
The report was ovarian carcinoma with MTS to peritoneum.
Patient was sent to Doctor xxx, who performed the operation removing the masses, the ovaries and the uterus.
Recovery after surgery was good, but patient continued to become more wasted .vomiting was persistent.
She became anemic and she was transfused; legs were swollen probably because of low albumins.
When the report of histopathology came (after about 1 month), it was surprising to everybody.
“Features of peritoneal MTS from gastric carcinoma (Krukemberg’s tumour)”
Surgeons decided there was no room for surgery.
I have tried with a single course of chemotherapy, but conditions have worsened steadily.
She was vomiting everyday.
She died within 2months.
LEARNING POINTS
- Gastric carcinoma can show itself in very tricky ways.
- We had to consider the past medical history of PUD because, although rarely, gastric ulcer can complicate with carcinoma.
- Even CT SCAN can mislead us.
- Surgery of stomach carcinoma is possible only in very early stages.
- Chemotherapy doesn’t work in gastric carcinoma.
- Life expectancy after stomach carcinoma is very short.
- Although more common beyond 40 years of age, ca stomach is possible even in young patients.
CASE REPORT 2
A 60 year old man from Moyale was treated for PUD for many years.
He was admitted in our hospital because of severe dehydration.
He was unable to retain anything. The complaint was that either solid or liquid food was reaching up to the lower part of the chest and then was coming up immediately and undigested.
The patient was anemic and had very swollen legs.
PAST MEDICAL HISTORY
At the beginning he was complaining of burning epigastric pains which were reaching up to the mouth.
Then later there was inability to swallow solid food while he could drink. Lately even drinking was impossible.
The patient was sent for U/S showing a much enlarged liver with multiple hypoechogenic masses, looking like MTS.
There was ascites. Pancreas was normal; kidneys were regular.
The patient underwent gastroscopy which found a surrounding mass at the distal 1/3 of the esophagus. The mass was covered with fibrin and easily bleeding on touch by the instrument. The lesion was causing impassable stenosis of the organ. Biopsies were taken and sent to Nairobi. When the results came 4 weeks later we confirmed our hypothesis of squamous cell carcinoma of the oesophagus.
Patient was referred to the University Hospital in Nairobi after receiving 1 pint of blood (HB was 5g/dl)
LEANING POINTS
- Dysphasia is to be considered a danger sign for CA esophagus.
- Severe dehydration together with inability to swallow is suspicious of CA esophagus.
- HIV of this patient was negative although even AIDS could give a similar picture due to wasting (slim disease and severe oral and esophageal thrush).
- CA esophagus is very malignant and causes MTS very quickly. It kills patients quickly.
- Anemia is due to chronic microscopic bleeding and malnutrition.
- Oedema is due to low albumin levels due to inability to feed.
The patient was not operated because of extensive MTS.
A percutaneous gastro-anastomosis was performed in order to feed the patient.
Chemotherapy was attempted but patient died in 6months.
It is therefore a very malignant carcinoma
7. Males more affected than females. More common beyond 50 years of age. For reasons so far unknown Northern tribes more prone to it.
GLOSSARY
HVS: HIGH VAIGNAL SMEAR
PT: PREGNANCY TEST
U/S: ULTRASOUND
PUD: PEPTIC ULCER DISEASE
PID: PELVIC INFLAMMATORY DISEASE
MTS: METASTASIS
CT SCAN: COMPUTERIZED TOMOGRAPHY (TAC IN ITALIAN)
CA: CARCINOMA
HB; HEMOGLOBIN
MOYALE: BORDER TOWN BETWEEN KENYA AND ETHIOPIA (EXTREME NORTH)
Bro Dr Giuseppe Gaido
Dr James Ogembo
Clinical Officers
Nursing Officers
Cottolengo Mission Hospital Chaaria
Nessun commento:
Posta un commento