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[Multiple carcinoids in the midgut causing intestinal gangrene--a case report]
F Graunke1, H U Völker, A Larena-Avellaneda
1Klinik und Poliklinik für Allgemein-, Viszeral-, Gefäss- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Strasse 6, Würzburg, Germany. Graunke_f@chirurgie.uni-wuerzburg.de
Zentralblatt Fur Chirurgie
|September 17, 2009
Summary
Multiple midgut carcinoids can mimic intestinal ischemia, a rare but serious condition. Early diagnosis and treatment are crucial for managing this rare presentation of carcinoid tumors.
Area of Science:
- Gastroenterology
- Surgical Oncology
Background:
- Carcinoid tumors, particularly midgut carcinoids, can present with complex gastrointestinal symptoms.
- Intestinal ischemia is a critical condition often requiring prompt surgical intervention.
Observation:
- A 77-year-old male presented with a 2-month history of postprandial abdominal pain, nausea, vomiting, and anemia.
- Extensive diagnostic workup, including imaging and blood tests, was inconclusive.
- Small-bowel capsule endoscopy revealed multiple bleeding sites, leading to exploratory laparotomy.
Findings:
- Laparotomy identified segmental small bowel ischemia, with resection of the jejunum/ileum.
- Pathological examination revealed eight midgut carcinoids producing serotonin, synaptophysin, and chromogranin.
- Despite re-operation for suspected ongoing ischemia, no further pathologies were found, and the postoperative course was uneventful.
Implications:
- This case highlights that midgut carcinoids can present symptomatically, mimicking intestinal ischemia, a rare occurrence.
- While elastic vascular sclerosis of the mesenteric artery is pathognomonic, its absence does not rule out carcinoid-induced ischemia.
- The extent of intestinal ischemia correlates with the stage of the carcinoid disease, emphasizing the need for timely diagnosis and management.
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