[Skip to Navigation]
Views 955
Citations 0
JAMA Oncology Clinical Challenge
August 27, 2020

Watery Diarrhea in a Patient With Metastatic Appendiceal Adenocarcinoma

Author Affiliations
  • 1Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado
  • 2Gastroenterology of the Rockies, Boulder/Denver, Colorado
  • 3Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
JAMA Oncol. 2020;6(11):1801-1802. doi:10.1001/jamaoncol.2020.2178

A 72-year-old man with recently diagnosed metastatic appendiceal adenocarcinoma undergoing chemotherapy with capecitabine plus oxaliplatin presented with lower abdominal pain and watery, large-volume diarrhea up to 15 times per day for the previous 3 weeks. His diarrhea was nonbloody, woke him up from sleep, was accompanied by crampy abdominal pain, and was not associated with nausea or vomiting. The diarrhea persisted despite treatment with combinations of loperamide, atropine/diphenoxylate, colestipol, and tincture of opium. He required repeated intravenous infusions for fluid and electrolyte repletion. His physical examination results revealed normal vital signs and a mildly tender abdomen with hyperactive bowel sounds, but no peritoneal signs. His laboratory workup results were notable for severe hypokalemia and hypomagnesemia, as well as positive fecal lactoferrin and elevated fecal calprotectin levels of 646 μg/g. His infectious workup results were unremarkable. A computed tomography scan of the abdomen/pelvis revealed diffuse long-segment wall thickening involving nearly the entire terminal ileum (Figure, A). An ileocolonoscopy revealed erythematous and congested mucosa with scattered erosions and ulcerations throughout the examined terminal ileum (Figure, B). Targeted biopsies were obtained (Figure, C).

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words