Pressure to treat can discourage physicians from carrying out the careful investigations needed for correct diagnosis. Here, we describe a case in which the correct diagnosis took several years, and became apparent only after a review of patient records revealed a decade-old surgical history of laparoscopic cholecystectomy performed for acute calculous cholecystitis.The patient, a hypertensive 78-year-old man, presented with fevers and increased abdominal pain 4 weeks after beginning chemotherapy for the presumed recurrence of a gastrointestinal stromal tumor. Three years previous to this presentation, he had undergone endoscopy during an evaluation for melena; the procedure had revealed a 1-cm submucosal abdominal mass that was identified by pathologic analysis as a low-grade gastrointestinal stromal tumor. The tumor had been removed by a partial gastrectomy without any further imaging studies, and because it was small and low-grade, with non-malignant surgical margins, no chemotherapy had been prescribed. The management plan had been to follow the patient by periodic abdominal imaging with computed tomography (CT).
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— Abhishek Agarwal, MD, Meghana Bansal, MD, Rebecca E. Martin, MD
This article originally appeared in January 2012 issue of The American Journal of Medicine.
