CORRECT HAND PALPATION –A PROVEN CASE TO DETECT MALIGNANCY

Gastric tumour if large enough can be suspected from proper abdominal examination. It can easily be missed if the doctor did not perform correct examination technique. A 59-year-old man, no known illness presented with isolated symptoms of abdominal pain for three weeks. He had sought attention to two primary care clinics and was reassured to have dyspepsia. However, his symptoms did not resolve. In line with WHO approach in primary care, we proceed with thorough clinical examination. Despite subacute presentation of less than one month, surprisingly there is a palpable mass at his epigastric area with irregular margin. Without initial imaging study, we referred this case urgently to the surgical team with a high possibility of gastric malignancy. Urgent CT scan was performed in which huge mass arising from posterior wall of stomach was revealed. He was then successfully managed with total gastrectomy and esophagojejunostomies. Postoperatively, he recovers well and benefit regular surgical follow up. This case highlights the importance of clinical examination in all cases that come to our attention. It might be missed if every medical professional assumes dyspepsia as gastritis and comes into diagnosis without proper examination.