A patient with gastroparesis is presented. Ultimately the diagnosis of paraneoplastic gastroparesis due to an occult small cell cancer of the lung was made. The difficulties in the diagnostic process and the pathogenesis of this very rare manifestation are discussed. 1. Introduction Gastroparesis, a chronic motility disorder, is characterized by upper gastrointestinal symptoms and leads to delayed gastric emptying. It negatively impacts morbidity due to inability of food intake, mortality due to the underlying cause, and discomfort that interferes with the quality of life [1]. There is no mechanical obstruction. Diabetes with poor glycaemic control and postsurgical causes represent the most common aetiologies. Gastroparesis also has been described as a complication of several malignancies, including gastric, pancreatic, gallbladder, oesophageal, and lung cancers, as well as leiomyosarcoma. The condition commonly manifests as upper gastrointestinal symptoms, including nausea, vomiting, postprandial fullness, early satiety, abdominal pain, and bloating [2]. Management of gastroparesis includes correction of malnutrition, dehydration and electrolyte imbalance, and relief of symptoms by use of prokinetic drugs. Mostly the cause of gastroparesis is obvious, and the condition can be treated accordingly. The prevalence of paraneoplastic gastroparesis is unknown, and this entity probably is widely underrecognized and undertreated. A case of extreme gastroparesis that ultimately proved to be due to an occult small cell carcinoma of the lung is presented. 2. Case Report A 74-year-old male patient was presented in the emergency department of our hospital because of repeated vomiting. He was known with complaints of prostate enlargement and hypertension, smoked for many years, and used excessive amounts of alcohol. His medication comprised of hydrochlorothiazide, enalapril, omnic, tamsulosine, and omeprazole. Eight months earlier he was seen at the out-patient clinic because of malaise, pain in the proximal muscles, anorexia, a feeling of fullness in the abdomen, mild anaemia, and an erythrocyte sedimentation rate of 48？mm. Polymyalgia rheumatica was suspected and empiric treatment with steroids was started with a remarkable result. The complaints disappeared completely and the ESR normalized. The steroids were tapered and after six months definitely stopped. One month after stopping his complaints recurred. Despite this he went on a holiday to Spain. During this holiday, he was admitted because of abdominal pain, nausea, and vomiting. He underwent upper GI
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