Malignant

Malignant. The name given to any doctor that seem to be very strict or 'kerek' in his/her own way. And today, we've got one. It was scary okay. This is our second time with him. The first one was on 31 January 2010, Sunday. As there are still two weeks for us in KAUH, we are looking forward to meet him again.

Okay lets forget about the doctor for a while. I'm not going to write or complain about him okay. It's the case that we discussed with him the other day that I would like to concentrate on.

It was about an old man complaining of suprapubic pain. I don't remember all of the details but the significant symptoms associated with the chief complaint are haemetemesis, melena and weight loss.

Haematemesis: Vomiting of blood
Melena: The passage of black, tarry stools composed largely of blood that has been acted on by gastric juices, indicative of bleeding in the upper digestive tract

During discussion..
This could be an upper gastrointestinal tract (GI) bleeding, which has several causes itself or it could also be from other pathology.
After an hour and a half of discussing, we end up diagnosing the patient as having either gastric cancer or colon cancer. But at that time, he was still under investigation.

Today, the doctor told us that the old man has died. He died the next day after the day we discussed his case. It was rather shocking and sad. We talked to and examined him just a day before his death. And more suprisingly, he did not suffer any cancer, neither gastric nor colon. He actually suffered from aorto-duodenal fistula. Our big mistake is that we didn't ask for any previous surgery, which is related to the pathology.

Aorto-duodenal fistula can be caused by previous reconstructive surgeries such as thromboendarterectomy or grafting of the abdominal aorta and patient may present with symptoms and signs GI haemorrhage. It's a rare disease.

It's true that what common is common, but what rare is also very important.