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Posted August 07, 2006 by publisher in Cuba Human Rights

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By LAURAN NEERGAARD | The Associated Press

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, even cancer.

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

Castro was said to be recovering “positively” on Tuesday after intestinal surgery to stanch 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. specialists dismiss the stress comment, saying that couldn’t be enough to trigger serious bleeding.

But a whole list of conditions can cause bleeding in the gastrointestinal tract. It’s impossible to know the true culprit without knowing where the bleeding originated: the stomach, small intestine, colon.

Still, only a few disorders are likely to cause enough bleeding to spur urgent surgery, and a condition called diverticulosis tops that list, said Dr. David Weinberg, director of gastroenterology at Fox Chase Cancer Center in Philadelphia.

Diverticula are balloon-like sacs that form along the digestive tract’s lining, usually in the colon. These weak spots become very common with increasing age, and sometimes intersect with an artery _ allowing blood to drain straight into the intestine, then out of the body.

“You see, typically, large amounts of usually painless bleeding, without warning that it’s coming,” Weinberg said.

Often, it heals on its own. Other times, doctors snake a tube, called an endoscope, into the colon to cauterize it. Or, surgeons may remove the section of intestine harboring the bleeding pouch, an hours-long operation.

Another suspect: ulcers, which are most commonly caused by bacteria called H. pylori or by medications, including aspirin and other anti-inflammatory painkillers.

In the United States, surgery for bleeding ulcers has plummeted in the last decade, thanks to acid-blocking medications.

But when surgery is needed, it can be complex, requiring removal of a part of the stomach, explained Dr. Parag Bhanot of Georgetown University Hospital. If that’s what Castro underwent, Bhanot predicted a seven to 10-day hospital stay and, barring complications, two to four more weeks of recuperation.

Bleeding can be a symptom of stomach and colorectal cancer. But sudden, obvious bleeding is uncommon from cancer, cautioned Fox Chase’s Weinberg.

Regardless of Castro’s diagnosis, “given certainly his age and the urgent nature of his procedure, he is at an increased risk for complications,” said Bhanot. “Not only his age but his overall health will really be the critical factor” in recovery.

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