Case Report
Treatment of acute, severe epigastric/chest pain in a patient with stomach cancer following gastrectomy: A case report
- Authors:
- Iwona Zaporowska-Stachowiak
- Lidia Gorzelińska
- Maciej Sopata
- Jacek Łuczak
-
View Affiliations / Copyright
Affiliations:
Palliative Medicine In-patient Unit, University Hospital of Lord's Transfiguration, Poznan University of Medical Sciences, Poznan 60-806, Poland
-
Pages:
1412-1416
|
Published online on:
January 19, 2015
https://doi.org/10.3892/ol.2015.2886
- Expand metrics +
Metrics:
Total
Views: 0
(Spandidos Publications: | PMC Statistics:
)
Metrics:
Total PDF Downloads: 0
(Spandidos Publications: | PMC Statistics:
)
This article is mentioned in:
Abstract
The treatment of acute chest pain can be a challenge in palliative care. Firstly, because acute chest pain is a symptom of a paucity of diseases, which makes diagnosis difficult and time consuming, while there is also a time constraint, due to the extreme suffering of the patient. Secondly, the condition of a patient with advanced cancer disease and co-morbidities does not always allow for required diagnostic procedures. The present report describes a case of acute, severe epigastric/chest pain in a patient with dynamic disease progression, who was receiving palliative care. This study also demonstrates that the pathophysiology of pain in a terminal patient may determine the treatment strategy. The patient in the present case was a 41‑year‑old male, who had previously undergone gastrectomy for stomach cancer, followed by postoperative chemotherapy. The patient was treated with palliative chemotherapy for metastases to the lungs, liver and lymph nodes, which led to the development of iatrogenic peripheral neuropathy. The patient was subsequently admitted to the Palliative Medicine In‑patient Unit of the University Hospital of Lord's Transfiguration (Poznan, Poland) with the complaint of acute epigastric and chest pain. An electrocardiogram, echocardiogram, chest and abdomen computerized tomography scan, esophagoduodenoscopy and laboratory analyses were performed to determine the source of the pain. The patient was treated with morphine sulfate, metoclopramide, midazolam, diazepam, acetaminophen, ketamine, hyoscine butylbromide, propofol, dexamethasone and amoxycillin, and received parenteral nutrition. As the source of pain remained unclear, a second esophagoduodenoscopy was performed to determine a diagnosis, resulting in pain relief. Thus, in the present case, esophagoduodenoscopy was diagnostic and therapeutic. Furthermore, although the treatment of acute chest pain may be a challenge in palliative care, the present study indicates that pain treatment should be adjusted to anatomical, pathophysiological and pharmacological factors, and may pose risks due to the unavoidable parenteral co‑administration of multiple agents with strong therapeutic effects.
View References
|
1
|
World Health Organisation. Cancer Pain
Relief. Second Edition. World Health Organisationl; Geneva: 1996,
Available from: http://whqlibdoc.who.int/publications/9241544821.pdf.
Accessed March 9, 2014
|
|
2
|
Baldi F and Ferrarini F: Non-cardiac chest
pain: a real clinical problem. Eur J gastroenterol Hepatol.
7:1136–1140. 1995. View Article : Google Scholar : PubMed/NCBI
|
|
3
|
Fass R and Dickman R: Non-cardiac chest
pain: an update. Neurogastroenterol Motil. 18:408–417. 2006.
View Article : Google Scholar : PubMed/NCBI
|
|
4
|
Rao SS: Diagnosis and management of
esophageal chest pain. Gastroenterol Hepatol (NY). 7:50–52.
2011.
|
|
5
|
Hong SJ: Diagnosis and management of
esophageal chest pain. Korean J Gastroenterol. 55:217–224. 2010.(In
Korean). View Article : Google Scholar : PubMed/NCBI
|
|
6
|
Noffsinger AE: Update on esophagitis:
controversial and underdiagnosed causes. Arch Pathol Lab Med.
133:1087–1095. 2009.PubMed/NCBI
|
|
7
|
Lemire S: Assesement of clinical severity
and investigation of uncomplication gastresophageal reflux disease
and non-cardiac angina-like chest pain. Can J Gastroenterol.
11(Suppl B): 37B–40B. 1997.
|
|
8
|
Hershcovici T, Achem SR, Jha LK and Fass
R: Systematic review: the treatment of non-cardiac chest pain.
Aliment Pharmacol Ther. 35:5–14. 2012. View Article : Google Scholar
|
|
9
|
Fass R and Navarro-Rodriguez T: Noncardiac
chest pain. J Clin Gastroenterol. 42:636–646. 2008. View Article : Google Scholar : PubMed/NCBI
|
|
10
|
Cannon RO III, Quyyumi AA, Mincemoyer R,
et al: Imipramine in patients with chest pain despite normal
coronary angiograms. N Engl J Med. 330:1411–1417. 1994. View Article : Google Scholar : PubMed/NCBI
|
|
11
|
Remes-Troche JM, Chahal P, Mudipalli R and
Rao SS: Adenosine modulates esophageal sensorimotor functions in
humans. Gut. 58:1049–1055. 2009. View Article : Google Scholar
|
|
12
|
Rao SS, Mudipalli RS, Remes-Troche JM,
Utech CL and Zimmerman B: Theophylline improves esophageal chest
pain - a randomized, placebo-controlled study. Am J Gastroenterol.
102:930–938. 2007. View Article : Google Scholar : PubMed/NCBI
|
|
13
|
Drenth JP, Bos LP and Engels LG: Efficacy
of diltiazem in the treatment of diffuse esophageal spasm. Aliment
Pharmacol Ther. 4:411–416. 1990. View Article : Google Scholar : PubMed/NCBI
|
|
14
|
Swamy N: Esophageal spasm: clinical and
manometric response to nitroglycerine and long acting nitrites.
Gastroenterology. 72:23–27. 1977.PubMed/NCBI
|
|
15
|
Azpiroz F and Malagelada JR: Gastric tone
measured by an electronic barostat in health and postsurgical
gastroparesis. Gastroenterology. 92:934–943. 1987.PubMed/NCBI
|
|
16
|
Rivera I, Ochoa-Martinez CI,
Hermosillo-Sandoval JM, et al: Dumping syndrome in patients
submitted to gastric resection. Cir Cir. 75:429–434. 2007.(In
Spanish).
|
|
17
|
Spiller R: Role of motility in chronic
diarrhoea. Neurogastroenterol Motil. 18:1045–1055. 2006. View Article : Google Scholar : PubMed/NCBI
|
|
18
|
Hinshaw DB, Joergerson EJ, Davis HA and
Stafford CE: Peripheral blood flow and blood volume studies in the
dumping syndrome. AMA Arch Surg. 74:686–693. 1957. View Article : Google Scholar : PubMed/NCBI
|
|
19
|
Ukleja A: Dumping syndrome:
pathophysiology and treatment. Nutr Clin Pract. 20:517–525. 2005.
View Article : Google Scholar : PubMed/NCBI
|
|
20
|
Deitel M: The change in the dumping
syndrome concept. Obes Surg. 18:1622–1624. 2008. View Article : Google Scholar : PubMed/NCBI
|
|
21
|
Likert R: A technique for the measurement
of attitudes. Arch Psych. 140:1–55. 1932.
|
|
22
|
Fass R, Malagon I and Schmulson M: Chest
pain of esophageal origin. Curr Opin Gastroenterol. 17:376–380.
2001. View Article : Google Scholar
|
|
23
|
Mellow MH, Simpson AG, Watt L,
Schoolmeester L and Haye OL: Esophageal acid perfusion in coronary
artery disease. Induction of myocardial ischemia. Gastroenterology.
85:306–312. 1983.PubMed/NCBI
|
|
24
|
Saunders CM: The challenge of terminal
care. Scientific Foundations of Oncology. Symington T and Carter
RL: Heinemann; London: pp. 673–679. 1976
|
