Authors: Francesca Malcolm, Graham Johnson / Editor: Mark Winstanley / Reviewer: Graham Johnson / Codes: SLO1, SuC10, SuC4, SuP2 / Published: 29/03/2022
A 72-year-old gentleman presents to the ED with a 3 week history of intermittent abdominal pain; it is now constant in nature and 8/10 in severity. It originates from an umbilical lesion and radiates into the RIF. He has felt nauseated for several days but has not vomited. He opened his bowels yesterday, passing normal stool. He is still passing flatus and has no urinary symptoms.
He is worried as he has been increasingly lethargic and has lost a lot of weight over the past 8 months.
His GP has diagnosed an umbilical hernia which has been present for several months. It is no longer reducible and has become hard. 1 month ago the ‘hernia’ started bleeding and was cauterised by the GP.
He has a past medical history of of atrial fibrillation, myocardial infarction, coronary artery bypass grafting, hypertension and heart failure.
All observations are stable.
On examination there is a red 3-4cm, umbilical mass which is crusted with blood. The surrounding area is tender and it has a negative cough impulse. Bowel sounds are unremarkable.
Deranged blood results of note: lactate 2.7, CRP – 56
20 responses
good learning points
I knew and have seen many different types of cancers involving lung, GIT and gyanecological etc systems being diagnosed in ED but it was surprising to know that a huge %(41) of bowel cancers being missed out of the ED land.
Thank you for this
Good case
concise learning points.
Good learning points. Thanks
Excellent reminders.
A very informative read.
thank you for the case
Very good learning points
This was a very interesting case which really made me aware of a diagnosis whichI would have missed.
Very good learning.
Important module. WIll help in daily practice in ED
WIll help in daily practice in ED
Previous diagnosis can bias your assessment.
Excellent. Lots of interesting learning.
Informative
good case
Thanks, good twist!
excellent case review