Information sourced from BMJ:
BMJ 2016;352:i1213
[Free full-text BMJ article PDF]
Minerva
Thomas’s sign
Ali Waqar, Giulio Preta, Hasan Haboubi
alibinwaqar@gmail.com
A woman presented with weight loss, jaundice, and silver coloured stools. CA19-9 was raised and computed tomography suggested a pancreatobiliary tumour. Silver coloured stool, or Thomas’s sign, is pathognomonic of carcinoma of the ampulla of Vater. The metallic colour is caused by the mixture of malaena and cholestatic pale stools. Ampullary cancers comprise about 0.2% of all gastrointestinal cancers. Although silver stools are thought to be a classic sign, data are limited. If caught early prognosis is thought to be good, highlighting the importance of obtaining an accurate history of stool colour change.
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