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History

The patient is a 52 year-old white male who was diagnosed with colon cancer 5 _ years ago and underwent surgical resection. The malignancy was localized at the splenic flexure and apparently had not spread outside the colon. He received adjuvant chemotherapy with 5FU/leukovorin for one year. At that time, he was found to have a metastatic lesion in the liver that was subsequently resected. A second lesion later developed in the liver and he underwent resection and placement of a hepatic arterial port for intra-arterial chemotherapy with 5FU/leukovorin/decadron. Despite intra-arterial chemotherapy, three new metastatic lesions were found in the liver. A trial of of irinotecan did not provide substantial results. He then underwent chemoembolization with multiple treatments to all lesions. One lesion was not amenable to chemoembolization and continued to grow. On 7/01, the patient developed a metastatic lesion in the abdominal wall that was later resected. On 1/02, the patient developed elevated liver function tests that were notable for cholestasis. Family members reported noting jaundice. On 1/9/02, he subsequently underwent an outpatient ERCP which revealed strictures likely due to FUDR. He had a 7 fr 15 cm cotton leung stent of his left hepatic ductal system.

The patient was doing fairly well until the week of 1/27/02. At this time the patient noted fatigue, fevers, increased jaundice and rigors. On 1/29/02 he presented to TJUH with temperature of 103, hypotension, leukocytosis of 14.8 B/L, and acute renal failure. On 1/30/02, he underwent an abdominal u/s which was suggestive of hepatic abscess. CT on the same day confirmed the presence of 2 large abscesses in the liver. CVIR was consulted for percutaneous drainage.

Prior to CVIR drainage, the patient had approximately 3 to 4 episodes of melena. He c/o mild RUQ abdomial pain and LH. He now recalls that about 1-2 weeks prior to admission he was experiencing intermittent melena. He denied the following: GERD, dysphagia, odynophagia, and n/v.

PMHx BPH
PSHx as above, cholecystectomy
FHx Father alive with prostate cancer, mother passed away with hx of SLE, ovarian ca
Soc no alcohol, no tobacco, widowed, pediatric and adolescent psychologist
NKDA
Meds metronidazole 500mg IV Q8h, ciprofloxacin 200mg IV Q 12h