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An unusual cause of watery diarrhoea
  1. John N Gordon
  1. Department of Gastroenterology, St Mary's Hospital, Newport, Isle of Wight PO30 5TG, UK
  1. Dr Gordon (email:jngordon{at}virgin.net)

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Answers on p 517.

A 40 year old housewife was referred with a nine month history of intermittent watery diarrhoea and intermittent abdominal pain. The diarrhoea occurred four to five times a day and there was no blood or mucus in the stools. Her only past medical history consisted of heartburn which was treated with ranitidine 150 mg twice a day by her general practitioner. She did not smoke and only drank occasionally. Physical examination revealed a 5 cm enlarged non-tender liver. Stool cultures revealed no growth. She underwent upper gastrointestinal endoscopy which revealed grade II oesophagitis and diffuse duodenitis and a small bowel series showed fine ileal ulceration. Colonoscopy was normal. Computed tomography of the abdomen showed multiple lesions throughout the right and the left liver highly suspicious of metastatic disease.

Questions

(1)
What is the diagnosis?
(2)
How would you confirm this?
(3)
What are the treatment options?

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