A Man With Diarrhea And Achalasia

摘要

A 78 y/o male with an extensive history of CAD s/pmultiple MIs and CABG surgery, presents with two andone half weeks of diarrhea. About 9 weeks prior, he hadbeen diagnosed with achalasia, and was treated with abotulinum toxin injection, with resolution of hissymptoms of dysphagia. He was also hospitalized a monthago after experiencing chest pain, and subsequently ruledin for a small non-ST elevation MI. He underwentcoronary catheterization at that time, and was found tohave severe multivessel disease unamenable to PTCA orbypass surgery. Now, he presents with progressivelyfrequent “brown watery” diarrhea for the past couple ofweeks, reporting up to 20 episodes a day, occurring alsoat night and causing episodes of fecal incontinence. Hedenies blood in his stools, or recent antibiotic use.Diarrhea is associated with abdominal cramping, and isnot relieved with Lomotil taken every 8 hours. Duringthis period, the patient also notes several episodes of nonbloody,non-bilious emesis, the last occurring one dayago, with an inability to tolerate po intake and a 10 lbweight loss over the two weeks. He denies recurrentdysphagia, fevers or chills, recent travel, heat intolerance,or palpitations. He had a routine screening colonoscopy6 years ago that was reportedly ‘normal’.