Journal of Gastrointestinal & Digestive System
Open Access

Abstract

Retroperitoneal fibrosis secondary to malignant disease is a rare condition associated with an ominous prognosis. We present the first reported case of retroperitoneal fibrosis related to metastatic adenocarcinoma of a primary occult tumor. This is a case of 64-year-old Caucasian male presented to the emergency department with his third episode of anuric acute renal failure despite bilateral ureteral stent placements and revision. A month earlier at first presentation with anuria, a CT scan revealed moderate bilateral hydronephrosis. He had an unprovoked DVT diagnosed 3 months prior. Examination demonstrated suprapubic tenderness and mild peripheral edema and no palpable lymphadenopathy. His creatinine was elevated at 5.42 and Hg low at 11.5mg/dL. CEA was elevated at 220.4, with normal CA 19-9, PSA and AFP. His IgG-4 (98mg/dL), LDH, ESR and CRP were elevated. Colonoscopy showed moderate diverticulosis of sigmoid colon with wall thickening. A F-18-FDG PET scan showed multifocal areas of metastatic malignancy in the neck, chest, abdomen, pelvis and bones. A liver biopsy showed infiltration by malignant epithelial cells in nests, consistent with gastrointestinal tract adenocarcinoma. Larger bilateral ureteral stents were placed and he was discharged 8 days later with normalised creatinine. Palliative outpatient chemotherapy was commenced. This case illustrates the importance of careful workup looking for an underlying cause of RF. Although malignancy is a relatively rare cause, its potential was highlighted by the unprovoked DVT, weight loss and smoking. The elevated CEA and subsequent PET scan led to a diagnostic biopsy. Recognition of this syndrome is critical in institution of appropriate therapy.

Biography

Renee Wong earned her Bachelor of Science with an Honor’s Specialization in Medical Sciences with Distinction from Western University, Canada, with participation in the Scholar’s Electives Research program. She is passionate about improving medicine through research and continually attaning and sharing knowledge. She is currently a 4th year medical student at St. Georgen’s University School of Medicine. Her recent publication includes a co-authored article “Nutrition Clinical Practice on Low Vitamin B12 in Patients in the Amputation Rehabilitation Unit”. She is a member of the American Academy of Family Physicians.