We present an unusual case of renal cell cancer (RCC) which relapsed with duodenal metastasis and unveiled itself by gastrointestinal (GI) bleeding. An 80-year old Caucasian gentleman with history of renal cell cancer status post nephrectomy 11 mo previously, presented with syncope and melena. Computed tomography scan of the abdomen revealed heterogeneous soft tissue mass in the right nephrectomy bed invading the duodenum. Upper GI endoscopic biopsy confirmed the presence of recurrent renal cell cancer. However, due to extensive metastatic disease, the patient was placed on palliative chemotherapy as surgical options were ruled out. Our case report reiterates the fact that renal cell carcinoma can recur with gastrointestinal manifestations and, although a rarity, it should be considered in a patient with a history of malignancy who presents with these symptoms.
A 21-year-old Caucasian man with a history of type 1 diabetes mellitus was admitted with complaints of persistent vomiting and abdominal pain for 2 days. Laboratory work revealed diabetic ketoacidosis, presumably secondary to non compliance. The patient was treated with intravenous fluids and insulin. The anion gap was normalized. However, he was not able to tolerate a liquid diet. Clinical examination revealed a slightly distended abdomen and positive bowel sounds. X-ray of the abdomen (Picture 1), followed by a CT scan of the abdomen (Picture 2) demonstrated radiolucencies and gas bubbles along the greater curvature, respectively (arrows), consistent with gastric emphysema. He was then continued on supportive management and nasogastric suction which led to gradual improvement in his condition.The other differential diagnosis for this condition is emphysematous gastritis. Gastric emphysema is benign compared to emphysematous gastritis which is generally associated with a much more ominous clinical course, requiring aggressive management with antibiotics and surgery in most cases (1).
We present a case of hypercalcemia in a 79-year-old female likely secondary to uterine leiomyoma. To the best of our knowledge, hypercalcemia due to a benign tumor has only been described in five cases. Of these above five cases, uterine leiomyoma was thought to be the cause of hypercalcemia in three cases.
Venous thromboembolism is a rarely described complication of diabetic ketoacidosis (DKA). We describe a 21-year-old male patient with poorly controlled type 1 diabetes mellitus who was admitted with DKA, presumably secondary to noncompliance, whose clinical picture was complicated by generalized thrombosis involving multiple venous locations including renal vein, pulmonary vasculature, external iliac and common iliac veins. The patient had no family history of any coagulation disorders and a hypercoagulabilty work-up remained negative. The patient was subsequently anticoagulated with heparin and discharged home on warfarin. To the best of our knowledge, this is the first reported case of multiple venous thromboses occurring as a complication of DKA with no other risk factors. We also reiterate that although rare, venous thrombosis should always be considered as a potential complication of DKA.
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