A case of recurrent diarrhea

Dr Pratham BysaniResident, Dept of Surgery, BJ Medical College and Civil

Hospital, Ahmedabad

Dr Chirag DesaiConsultant Oncologist

A case of recurrent diarrhea

• A 48 year old male was seen for recurrent diarrhoea.

• He was unwell for past three years with recurrent explosive diarrhea and vomiting, so much so that he would loose several kilograms of weight during these episodes and would complain of severe weakness and cramps.

• He was admitted on number of occasions for his diarrhea.

• Every time stool examination was essentially normal and he would be treated with intravenous fluids and antibiotics and would eventually settle down.

• He had a full length colonoscopy which showed a tiny polyp in the cecum but nil else. Barium follow-through’ and abdominal sonography were both normal

• Over past three years he had lost about 12 kg. Weight.

• He was otherwise fit and well and had no other medical problems.

• Family history was unremarkable.

• On examination he looked well and detailed examination was normal.

• He was advised to come again when he had diarrheal episode. Soon he had one and he was admitted again.

• Physical examination was normal again and stool examination was normal too.

• His CBC, Urea, Creatinine and LFT’s were normal. • There was mild Hypokalemia. • He was taken for jejunal biopsy when we

detected multiple duodenal ulcers in 1st, 2nd and 3rdpart. Multiple biopsies were taken to rule out Crohn’s disease.

• Biopsies did not reveal any granuloma.

What will you do now?

Analysis

• Diarrhea is episodic; In between well• No blood• No fever• No bloating, flatulence• No extra intestinal manifestations• No drugs• Weight loss present• Colonoscopy and barium follow through normal

Neuro Endocrine Tumor