Male, 75 years old, Billroth II partial gastrectomy (gastroyeyelocalization) at 21 years old.
Chronic low back pain treated symptomatically with paracetamol and metamizole.
He was admitted 2 years earlier for acute biliary pancreatitis.
In oral endoscopy: mucosa meta-anastomoses of gastrectomy.
A programmed cholecystectomy was performed.
For several weeks she had back-lumbar pain radiating to right flank and hypochondrium, with nausea and hypopnea, and in the last few days she referred feverish coloration 24 hours before skin, urine
On physical examination, febricula, fever 2 or C), cutaneous authenticity and urticaria.
Fixation pain in the epigastric region and right hypochondrium with hepatomegaly of 7 cm at the costal margin.
Blood tests revealed: hyperbilirubinaemia (total bilirubin 3 mg/dl) with indirect predominance (direct bilirubin seizure 0.02 mg/dl), very high LDH (2,460 mU/ml alkaline phosphatase)
In addition, mild renal failure (urea 58 mg/dl creatinine 1.3 mg/dl).
Blood count showed moderate anemia (Hb 8.1 g/dl; Hto 24.3%) macrocytic (CMV 102) with normal white and platelet series.
Peripheral blood smears with frequent schistosomiasis and some spherocytes.
Direct negative Coombs test.
Low haptoglobin (3 mg/dl), elevated erythrocytes (7.3%).
Serum vitamin B12 and serum and intraerythrocytic folic acid were normal.
Coagulation: hypoprothrombinemia unaffected, fibrinogen normal.
Urine: urobilinogen and bilirubinuria positive.
HBV serology, HIV HCV negative.
Tumor markers: CEA elevation (66 ng/ml, VN < 5 ng/ml) and CA 19-9 (82 U/ml, VN < 37 U/ml).
In gastroscopy: in gastric stump, 5-6 cm proximal to anastomosis, raised lesion of 25-30 mm, with areas of ulceration and necrosis, friable, with a well differentiated intestinal consistency at biopsy, well differentiated adenocarcinoma.
Computed tomography (CT) revealed hepatomegaly with multiple hypodense lesions of different sizes, disseminated in both lobes, compatible with liver metastases.
Palliative symptomatic treatment was prescribed.
The patient died 20 days after diagnosis.
