Male with suspected cecal cancer

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Reference no: EM133816676

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This 82 y.o. male with suspected cecal cancer (refusing treatment) who resides in a nursing home was brought to the ED due to shortness of breath and some agitation. Physical exam revealed tachypnea with right base rales, tachycardia and tender bilateral lower quadrants and dry mucous membranes. Chest x-ray showed opacity suspicious for pneumonia or aspiration. CT angiogram of abdomen/pelvis showed no aneurysm/dissection of the abdominal aorta but findings showed the suspected colonic malignancy with high-grade small bowel obstruction (SBO) due to obstructing mass of the cecum. There was also suspicion for ischemic enteritis and intra-abdominal lymph node metastases and focal sclerosis of the left sacral ala suspicious for osseous metastasis. Tachycardia improved with IVF resuscitation. Empiric Zosyn was started but suspicion was low for respiratory infectious process. The patient was diagnosed with chronic schizophrenia many years ago and has been maintained on daily Amantadine, Remeron, and Zyprexa. He was noted to have brief episodes of agitation and verbal hallucinations. He was seen by inpatient psychiatry and treated with Risperidone 2 mg for mild acute exacerbation of schizophrenia, which resolved by the time of discharge. He was evaluated by General Surgery and recommended surgery but the patient continued to refused

Reference no: EM133816676

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