Medical experts scoff at stress claim

WASHINGTON — Although U.S. doctors can only speculate on Fidel Castro's health, his self-described symptoms could signal severe ulcers, a colon condition called diverticulosis or, an outside possibility, cancer.

Whatever the cause, major abdominal surgery in a soon-to-be 80-year-old is risky, made more so if Castro is weakened from prolonged bleeding. Pneumonia, blood clots and other life-threatening complications can crop up in the critical first days of recuperation.

Castro has been in visibly declining health for some time and has Parkinson's disease, according to the CIA.

He was said to be recovering "positively" Tuesday after intestinal surgery to stop what was described as sustained bleeding. In a statement attributed to Castro, the Cuban leader blamed stress for "an acute intestinal crisis" that would require "complicated" surgery and weeks of recovery.

U.S. medical specialists dismissed the stress rationale, saying Tuesday that couldn't be enough to trigger serious bleeding, although it could exacerbate an existing medical problem.

"Stress is not playing a role here as far as I'm concerned," said Jeffrey Raskin, the University of Miami's interim chief of gastroenterology.

Seven gastroenterologists interviewed said the statement did not include enough information to determine the underlying cause of the bleeding.

Jamie Barkin, chief of gastroenterology at Mount Sinai Medical Center, noted the word "complicated" in the official statement, because most gastroenterological work is fairly straightforward. "Either that's a publicist's word or there's something wrong with him that's really bad," Barkin said.

With what little they did know, several doctors speculated the most likely cause was a bleeding ulcer. That condition is usually treated with drugs and endoscopy, in which a tube is snaked into the intestinal tract to stem the bleeding by cauterizing, or burning, the wound until it closes.

Peter Kelsey, a Harvard gastroenterologist, said bleeding peptic ulcers — lesions in the stomach or the top part of the small intestine — are the most common cause of "high-volume, life-threatening" intestinal bleeding.

Most ulcers are caused by some combination of a bacterial infection and the use of common painkillers such as aspirin and ibuprofen, Kelsey said.

In addition to an ulcer, medical experts named several other possibilities for Castro's bleeding:

• Diverticulosis: Small pouches that hang from the colon. They sometimes cause bleeding and, on rare occasions, enough to require surgery.

• Colon cancer: It can cause bleeding, but the bleeding is usually limited.

• Mesenteric ischemia: A blockage of blood flow to the intestines, leaving dead tissue, which sloughs off, oozes and bleeds.

• Varices: Dilated blood vessels, typically in the esophagus, that can rupture or bleed. Usually caused by cirrhosis or other liver disease.

• AVM (arteriovenous malformations): Abnormalities in the connections between veins and arteries that can lead to bleeding, particularly in the elderly.

Material from The Washington Post is included in this report.