A 94-year-old male was admitted to the hospital with a chief complaint of abdominal pain and loss of weight. The patient had a history of coronary artery disease and myocardial infarction. There is no history of coronary bypass surgery. The patient had a nebulizer at home and takes metoprolol. These medications were continued during the patient’s stay. Physical examination revealed abdomen to be tender to palpation in the left mid and lower quadrants with some rebound. Bowel sounds were present, and there was no guarding. Blood pressure was normal. Pulse, respirations, and temperature were normal.
During hospitalization, EKG showed sinus rhythm with myocardial changes of ischemia. Sputum cytology was suggestive of adenocarcinoma, compatible with bronchoalveolar growth. Chest x-ray showed metastatic lesions and chronic obstructive lung disease in both lung fields. Barium enema showed adenocarcinoma of proximal sigmoid colon. Abdominal series showed no evidence of obstruction, but moderate dilation of his transverse colon was evident. Patient was seen in consultation, and it was decided to do as little as possible at this time due to the patient’s age and lung conditions.
The patient agreed with this approach and requested discharge to home to receive hospice care.
DISCHARGE DIAGNOSES: Carcinoma of sigmoid colon. Probable metastatic bronchogenic carcinoma. End-stage chronic obstructive lung disease. Coronary artery disease. Previous myocardial infarction.