Case 33-2013: A 40-year-old woman with abdominal pain, weight loss, and anxiety about cancer

摘要

Dr. Justin Chen (Psychiatry): A 40-year-old woman was seen in the emergency department at this hospital because of abdominal pain, nausea, anorexia, and weight loss, and she said, "I think I have pancreatic cancer." The patient was in her usual health until approximately 15 months earlier, when abdominal bloating and intermittent rectal pain and bleeding developed. On examination by a colorectal surgeon, palpation of the levator ani muscle replicated the pain. Flexible sigmoidoscopy revealed internal hemorrhoids. Diagnoses of levator ani muscle spasm and irritable bowel syndrome were made. Five months before presentation, intermittent nausea and eructation developed; rectal pain and constipation persisted, with occasional blood in the stool after straining. Four months later, repeat flexible sigmoidoscopy revealed no new findings. Nausea (with coughing up or vomiting a small amount of blood), anorexia, epigastric and left upper quadrant pain, increased bloating, and gas developed, with one episode of diarrhea. The. patient" went to the emergency department at another hospital, where computed tomography (CT) reportedly revealed a possible fullness in the body and tail of the pancreas (i.e., the distal pancreas). During the next week, constipation alternated with diarrhea, without melena or hematochezia. Nausea was most severe 20 minutes after eating; she took antacids and famotidine, without improvement. Two days before this evaluation, anorexia developed, and she stopped eating. Her husband brought her to the emergency department at this hospital.