- The Washington Times - Tuesday, August 1, 2006

U.S. gastroenterologists say they would need more information to diagnose the undisclosed medical condition that caused Fidel Castro’s “sustained” intestinal bleeding, but diverticulosis is a strong possibility.

The Cuban leader underwent “complicated” surgery Monday.

Diverticulosis is a condition marked by weakened spots in the lining of the colon that form sacs or pouches, which can become inflamed and bleed. It requires surgery, and patients sometimes have a large segment of their colon removed to stop life-threatening bleeding.

“It sounds like he had a pretty extensive internal hemorrhage … a massive hemorrhage,” said Dr. Timothy Koch, director of the division of gastroenterology at Washington Hospital Center.

If the problem was diverticulosis, he said, Mr. Castro would “probably need two or more weeks rest” and then be fine.

But the picture would be far more bleak, he added, if Mr. Castro had a drinking problem and developed cirrhosis, or as a chronic smoker suffered blocked blood vessels, or ischemia, which results in reduced blood flow to the intestines.

Mr. Castro reportedly quit smoking in the 1980s.

“If you smoke all your life, it can cause massive bleeding from the gut,” because the intestinal lining dies without blood, Dr. Koch said.

He added the “risk of death is high” with intestinal bleeding from ischemia or cirrhosis. “Mortality is in the 70 to 80 percent range.”

Both those conditions would require complicated surgery, Dr. Koch said.

U.S. doctors speculating on Mr. Castro’s condition also haven’t ruled out ulcers or colon cancer.

Ulcers are a common cause of bleeding of the stomach or upper intestine, but most specialists say they doubt an ulcer is Mr. Castro’s problem.

“Complicated surgery is usually not required with ulcers. You usually just over sew the ulcer with a couple of stitches,” Dr. Koch said.

However, Dr. Stephen Hanauer, gastroenterology chief at the University of Chicago Hospital, said it’s possible Mr. Castro suffered a perforated ulcer.

“Ulcers are the most common cause of bleeding in the upper intestine, and diverticular disease is the most common cause of bleeding in the lower intestine or colon,” he said.

Both Dr. Hanauer and Dr. Jorge Herrera, a professor of medicine and director of the Division of Hepatology at the University of South Alabama at Mobile, Ala., said it’s also possible Mr. Castro has colon cancer.

“I suspect he would have had cancer screening,” Dr. Herrera said.

Observers said Mr. Castro looked thinner than normal and somewhat weary in his last public appearance a week ago. Dr. Herrera said that would suggest whatever the medical problem, it is serious.

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