The patient: “Wilfred,” a 67-year-old retired anatomy professor and the husband of a long-time patient of mine.
Why he came to see me: Wilfred, who had been in abundant health, developed acute abdominal pain. When all of the tests performed by his primary care doctor came back normal, the doctor wrote off his pains as “gas.” He came to me feeling quite concerned about his now-recurrent pain, which was in the right upper quadrant of his abdomen and produced “referred” pain above his right shoulder.
How I evaluated him: The referred pain that Wilfred described is a classic expression of gallbladder disease yet the ultrasound of the gallbladder that his GP had ordered found no stones, retained bile or other evidence of disease. Wilfred noted to me that he had been pursuing a mostly vegan regime but had recently enjoyed some steak and that within half an hour had experienced the same stabbing pain in the gallbladder region, with associated dramatic belching.
How we addressed his problem: I told him that although I was glad the ultrasound of the gallbladder showed no disease, his symptoms strongly led me to believe that there was something amiss with his gallbladder and I wanted him to be seen at Yale. Since I had no connections in the gastroenterology department there, I sent him to the emergency department.
Wilfred’s background as an anatomy professor served him well, as his description of their busy emergency department sounded a bit like a MASH unit in a war zone, with cots lining the corridors and multiple trauma patients loudly crying out. He was able to convince them to perform an abdominal CT scan, which revealed a two-millimeter tumor of the gallbladder near the entrance to the common bile duct!
A Yale surgical team removed the gallbladder via a four-inch incision rather than laparoscopically, which is less invasive but more risky for this sort of rare tumor. The surgeon didn’t want to take any chances on missing any tissue that needed to be removed. Although the tumor proved to be malignant, there was no evidence of metastasis.
The patient’s progress: Wilfred will return next week to consult with Oncology at Yale to discuss the need for any follow up care…as I told him that I, quite frankly, had no idea what would be prudent in this unusual situation. I’m thankful for gifted surgeons and a persistent patient who helped us get proper care for this man in these rather challenging times.