Sivanesan was a 70 odd years old male. A seemingly healthy old man had an episode of weight loss and on a not so fine day he collapsed all of a sudden. He was rushed to a hospital in Chennai by his family members. Thereafter a series of tests were conducted that showed a mass in the pancreatic head and jaundice by the hospital. So doctors thought it could be pancreatic cancer. Were they right? Was their diagnosis right? Let us get the whole story.
Sivanesan’s Diagnosis
The patient apparently had low sugar and that was the reason he collapsed. Sivanesan showed signs of jaundice. That apart, further evaluations showed that the kidney parameters were changed. Routine scan also showed a mass of structure present in the pancreas. He then underwent such tests like ERCP, EUS, Cytology with the evaluation that he might be suffering from pancreatic cancer. A marker called CA19-19 Tumor marker was elevated in the reports and hence pancreatic cancer was suspected. But at the same time, multiple biopsy were taken and every biopsy results came negative for cancer and this contributed to the inconclusiveness. The patient was said that he might need surgery for pancreatic cancer which he did not carry out as none of the diagnosis came conclusive. Meanwhile he had almost spent a fortune, around 11 Lakh rupees on diagnosis alone. He was allowed to recuperate while he was admitted in the hospital. This arrested his weight loss in a period of 4 months and this was indeed the only consolation in his case. It was at this juncture he came to me.
Sivanesan’s Interesting Past
The patient, Sivanesan showed me the complete diagnostic reports as he came and visited me. The only consolation for the last 4 months was the weight loss he had getting arrested for. This actually made me strongly think that if cancer was present, it was an absolute non-possibility. The jaundice he had was due to the stricture present in the common bile duct. He had undergone ERCP stenting for this condition and that was working. The gallstones present were also the reason for jaundice. WIth all these in mind, I suspected something in the pancreas and I asked him to narrate his complete medical history as he can remember.
The patient, as he sat before me, started to narrate his side of the entire story. I asked him specifically to tell me anything that he might remember which had a serious effect on his health. He told about a traditional feast he attended in one of his relative’s places after his marriage, some 40 years ago. He had a bad stomach that instance and he was rushed to a famous hospital where he was treated by a famous gastroenterologist. The specialist had thoroughly examined him and he was told that there may be some problem with his pancreas and that may have been the reason for his bad stomach. He was advised by the doctor not to take non-veg food and alcohol. He added that he had developed diabetes within a year of this episode.
Pancreatitis – My Diagnosis
After listening to his story, I came to the conclusion that he should be suffering from just Pancreatitis and not pancreatic cancer as none of the cancer diagnosis were conclusive that he had pancreatic cancer. I prescribed him medicines for pancreatitis and the patient Sivanesan is stable now.
The final diagnosis was acute pancreatitis leading to Common Bile Duct stricture. I did a gallbladder removal surgery on the patient which is the standard procedure to treat the condition of gallstones. While performing the surgery I observed that the pancreas itself has become a mass and clinically no evidence of cancer in the pancreas was present. Despite my clinical observation, I took a biopsy of the pancreas and the result came negative. The patient is currently undergoing treatment for CBD stricture. This medical incident goes on to show that despite all investigations done as per protocol, the abdomen will remain a pandora’s box. Needless to say that talking to patients and allowing them to let us doctors know the entire medical history, no matter when it happened, can give important clues on the medical conditions.
