What caused this man's weakness and fatigue?

One early morning, the patient's partner checked on him while he was sleeping in a recliner. The patient informed her that, while his feet were on the floor, he didn't have the strength to move.

The patient's partner helped him get dressed and immediately took him to PresNow 24/7 Urgent and Emergency Care in Albuquerque, New Mexico where the man met with Lawrence Gernon, one of the doctors there.

The man told Gernon that he had three teeth removed five weeks earlier. After taking 10 days of antibiotics as instructed, he felt fine — until earlier that week when he started feeling fatigued. Days later, he was so tired after his daily hike that he took a nap when he got home, despite never taking naps normally. Then, that night, the man experienced diarrhea, having to visit the bathroom around a dozen times overnight. Around the same time, his congestion and runny nose worsened.

While examining the patient, Gernon noticed that the man's heart was beating rapidly and his oxygen levels were low. His mouth looked normal, but he was congested and had significant tenderness when Gernon pushed on the lower left side of his abdomen.

The man's belly also looked distended, so Gernon ordered a tube be inserted through the man's nose into his stomach. Almost immediately after doing so, dark brown fluid came out of the tube into the connected chamber.

CT scans and X-rays found the man's sinuses and lungs were fine, but the CT scan found that within the section of the man's gut where the large intestine connects to the small intestine, the walls were thickened and so swollen that the passage had been completely closed off for four to five inches. In addition, the tissues surrounding the tube showed streaks of inflammation, and his gut was obstructed by what appeared to be a tumor.

A surprise during surgery

The patient was taken to Presbyterian Rust Medical Center where he met Kevin Hudenko, the surgeon assigned to his case.

Hudenko told the patient he wanted to proceed with a laparoscopic procedure where small cameras and instruments would be inserted through small slits in the patient's abdominal wall rather than a single large incision.

During the procedure the next day, Hudenko found the spot where he expected to find the blockage and a thick, yellowish liquid that looked like pus came out between the separated loops of small bowel. Hudenko continued searching and found that behind the wall of the man's intestines was a hole at the base of his appendix. That's when Hudenko realized the man didn't have cancer, he had a ruptured appendix.

Typically, appendicitis causes fever and abdominal pain, but the patient had experienced neither. When the appendix is only surrounded by intestines, away from the peritoneum, it can rupture but cause almost no pain, Sanders reports. The small intestines are able to move around the abdominal cavity freely, and when they came in contact with the patient's ruptured appendix, the loops of bowel became sticky with inflammation and formed a wall around the injury.

Following the surgery, Hudenko informed the patient that he did not have cancer, and the patient made a quick recovery, going home a couple of days later, Sanders reports. (Sanders, New York Times Magazine, 1/10)

While most people don't anticipate becoming a "medical mystery," the path to an accurate diagnosis can be "surprisingly complex, strewn with cognitive land mines, logistical roadblocks and red herrings." Writing for the Washington Post, Sandra Boodman offers five tips for patients on how to avoid becoming a medical mystery.