He was very angry and desperate when he was first presented to us complaining of a three months’ watery diarrhea. This male patient, in his fifties, started his speech wondering if his condition has no diagnosis or treatment in medicine.

To tell the story:

He had cancer bladder for he was operated with cystectomy and ileal bladder substitution.

 

He was quite well till he started to develop gradual progressive watery diarrhea for which he sought multiple medical advices and took numerous medications in an attempt to stop this ominous diarrhea but with no value. So he was very frustrated, as we firstly saw him we were surely impressed that this patient was not suffering from actual diarrhea, we depend in this on the absence of the signs that must be present in a patient with severe diarrhea for the past months.

 

We went to examine this patient minded by this notion to ascertain it, on examination we were astonished by severe maceration of the peri-anal area which was impressive that it is not just diarrhea, it is an irritant one. Our hunch was towards the urine, could be diarrhea, as a post-operative fistulous formation.

 

So we advised the patient to revise his operator, who he was strongly  believing in him, so it was a hard task to convince the patient to go back to him. From that day I didn't see this patient except since 3 days, he told us, when he went to his operator who strongly denied my suggestion, it seems that our diagnosis was ironic, so he advised him to to let this silly thing and go to another gastroenterologist. He went to others with no change except towards more severity of the condition, he also noticed decreasing his urine output that coincided with increasing diarrhea severity, reaching fearsome degrees (nearly anuric).

 

When he presented for the second time he was in complete trust in his operator's opinion that everything is O.K. and the problem is still the diarrhea of unknown cause and treatment. By difficulty we persuaded him to do ascending urography  " see photos".

 

Do you think that these photos were convincing for the patient?

Don't be surprised when we say "NO", he didn't accept and continued to say " my operator tells the truth.." we replied we are not in a quarrel with your operator, we also did not know him, it is a complication that can occur at any time.

 

In order to satisfy him by this diagnosis we advised him to defecate after the ascending urography, as he saw by his own eyes the dye passing instead of stool, he accepted !!

 

This was a situation for failure of facts and logic when they came up against the raw power of belief.