After weeks of discomfort, the 25-year-old man got a shocking explanation for his abdominal pain.
The 25-year-old man was shivering. Although the weather in Milwaukie, Ore., was cold and rainy that March evening, his apartment was too warm to explain his chills. He had been having abdominal pain for the past several weeks, but that night it was excruciating — like a knife plunged deep into his belly, sharp and burning. All the strength seemed to seep from his body, and he thought he might pass out. That’s when he asked his roommate to call 911.
The E.M.T.s were concerned by the man’s pallor and low blood pressure and took him to Kaiser Permanente Sunnyside in Clackamas, just north of the small town where he spent much of his childhood. In the E.R., initial blood tests showed that he had lost a tremendous amount of blood — nearly half the blood in his system. The man shook with cold beneath the several blankets layered over him. With trembling hands, he signed the consent forms for a transfusion to replace some of what he had lost.
Months of Bizarre Symptoms
It had been a strange winter. In January, he noticed a bulge in the left side of his abdomen while taking a shower. He pressed on it, and it disappeared, only to reappear when the pressure was released. It didn’t hurt, but it was weird and new. He got in to see a physician assistant 10 days later. The P.A. couldn’t see or feel the lump but ordered an ultrasound to look for it. And they found it: a mass the size of a large grapefruit, about six inches in diameter.
Three weeks later, before any follow-ups had been planned, the man was sent a Valentine’s Day lunch by his girlfriend. He had just started eating when he developed a stabbing pain in his abdomen. It lasted less than a minute. But every mouthful after that moment triggered the same searing pain — even water. He drove himself to a nearby urgent care center. A CT scan showed clearly that the grapefruit of fluid now filled his entire upper abdomen, compressing his stomach, pancreas and spleen. He was admitted to the hospital.
Before Dr. Amit Sadana, the gastroenterologist assigned to his care, met the patient the following day, he had already reviewed the images showing the mass. It was probably digestive enzymes leaking from the pancreas into the abdomen. The man’s body had responded by walling off the fluid with inflammatory cells, forming what is called a pseudocyst. This was usually seen after trauma — often a serious car accident in which the seatbelt was slammed against the abdomen. The man recalled an accidental hit sustained while wrestling in the snow with a friend a couple of months earlier. Sadana looked dubious — it usually took more force than that.
In any case, the doctor said, he could put a tube into the pseudocyst and let the fluid flow into the man’s stomach. That would reduce the pressure and allow the inflammatory mass to resolve. That was done the next day, and for the first time in weeks, the young man was able to eat and drink with no pain. He was sent home a day later; the plan was to let the fluid drain for three or four weeks and then remove the tube. Sadana sent the fluid to the lab to see if there was something else going on. The results showed no evidence of cancer. Pancreatic cancer is rare in someone this young, but it could cause a leak of pancreatic fluid. And it’s not a diagnosis you want to miss.