Diarrhea and Weight Loss in a Recent Émigré

Abstract

LINICAL PRESENTATION: A 46-year-old woman preented to the emergency department with chronic complaints f diarrhea occurring about 30 minutes after meals and a 40ound weight loss over 2 to 3 months. The diarrhea was peristent after each meal and was unresponsive to diet changes. he patient had recently emigrated from Poland and did not eek medical attention there. She also complained of a longtanding, vague discomfort in her epigastrium but no increasing f the pain in time before admission to the hospital. She had een self-medicating with Ibuprofen for this pain. She denied any medical or surgical history. The patient reorted that she smoked 0.5 to 1 packs of cigarettes per day and rank alcohol socially. Physical examination revealed a malnourished woman with evere dehydration. She appeared ill and had mild tachycardia HR 100-115) with a normal blood pressure and temperaure. The cardiopulmonary examination was unremarkable. he had a nontender, scaphoid abdomen with no palpable asses or hernias. Rectal examination was normal and negative or occult blood. The initial laboratory studies illustrated severe hypernatreia (Na 166 mEq/l), hypokalemia (K 2.9 mEq/l), and metaolic acidosis (HCO3 5 mEq/l). She was admitted to the intenive care unit for resuscitation. After appropriate intravenous ydration, her laboratory studies markedly improved. Carcinombryonic antigen levels were slightly elevated (7.14 ng/ml), nd CA 19-9 levels were normal (29 ng/ml). On abdominal computed tomography (CT) scan, the solid orans appeared normal. The stomach and colon were poorly visulized but did appear to have a connection between them. Also, a ystic mass was in the lower abdomen unrelated to the stomach and olon most consistent with a mesenteric cyst (Fig. 1). Colonoscopy evealed scattered small diverticuli in the sigmoid and descending olon and a chronic inflammatory mass at the hepatic flexure with