The Case of the Award-Winning Actor With Multiple Diseases and Numerous Operations

Albert B. Lowenfels, MD

Disclosures

August 04, 2006

Introduction

Chief Complaint: The patient was a 72-year-old male actor who complained of weight loss, anorexia, abdominal fullness, nausea, and heartburn.

Present Illness

His digestive complaints began 4 months prior to admission, and by the time he was hospitalized, the patient had sustained a 20-pound weight loss. Abdominal pain had increased over time: prior to admission, the patient stated: "It feels like I've swallowed broken glass." On the basis of results of preoperative tests, the patient was thought to have "gallbladder trouble," but there was a suspicion of an additional lesion in the stomach. Shortly after admission, the patient underwent an extensive 9-hour abdominal operation which included total gastrectomy and cholecystectomy.

Past Medical History

The patient had several prior surgical operations. At age 57, 15 years prior to his abdominal operation, a pneumonectomy had been performed. Three years prior to his final illness, a prostatectomy had been performed to treat his benign prostatic hypertrophy. Eight months prior to the onset of his digestive tract symptoms, he had undergone open heart surgery.

Family Medical History

Mother and brother both died of cancer. Father died at age 53 with respiratory insufficiency.

Social History

Heavy smoker. Drank alcohol, sometimes consuming several drinks per day.

Subsequent Course

Patient returned home a month after his abdominal surgery. He received external radiotherapy to the abdomen. Three and a half months after his initial abdominal operation, he was reoperated because of signs and symptoms of intestinal obstruction. Chemotherapy was not administered, but he was given a course of interferon. However, his condition continued to deteriorate, and he died 5 months after the first abdominal operation.

Who was the patient?

  1. Humphrey Bogart

  2. John Wayne

  3. Steve McQueen

  4. Charlie Chaplin

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What was the reason for the pneumonectomy?

  1. Bronchiectasis

  2. Lung abscess

  3. Lung cancer

  4. None of the above

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What was the reason for open heart surgery?

  1. Coronary insufficiency

  2. Replacement of the aortic valve

  3. Repair of atrial septal defect

  4. Replacement of the mitral valve

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What was the cause of this patient's final illness?

  1. Cholecystitis with cholecysto-gastric fistula

  2. Gallbladder cancer

  3. Stomach cancer

  4. Cancer of the pancreas

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In which film did the patient's character suffer from the same illness that the actor had developed in real life?

  1. True Grit

  2. The Shootist

  3. The Man Who Shot Liberty Valance

  4. The Green Berets

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