JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
Jejunal Carcinoid Tumors Presenting as Small Bowel Obstruction David Ballard, MD; Ryan Fransman, MD; Guillermo Sangster, MD; Matthew Ayo, BS; Navdeep Samra, MD
Carcinoid tumors are themost common formof gut neuroendocrine tumors, however, they rarely present with small bowel obstruction. We present a case of a 65-year-old woman without prior abdominal operations who presented with symptoms of small bowel obstruction. Computed tomography (CT) showed multiple air fluid levels and a transition point in the left mesentery with two soft tissue densities at the same level. The patient was taken to the operating room for surgical exploration, which showed two intramural masses in the mid and distal jejunum, which surgical pathology showed to be stage IIIB carcinoid tumor.
FIGURE 1A: Axial noncontrast CT image of the mid abdomen demonstrates two irregularly marginated solid mesenteric masses (arrows) causing mild proximal small bowel dilatation.
INTRODUCTION
Although carcinoid tumors are rare, they are the most common form of gut neuroendocrine tumors. The annual incidence of carcinoid tumors is 4-5 cases per 100,000 people, increased from the previous estimation of 1.5 per due to better diagnostic tests and tumor detection techniques. The most common locations for gut carcinoid tumors in descending order are small intestine, rectum, stomach, colon, and appendix. The peak incidence of carcinoid tumors is in the sixth decade of life. 1-4 Carcinoid tumors are often asymptomatic and rarely cause obstructive symptoms. We present a case of a patient with a virgin abdomen presenting with small bowel obstruction due to carcinoid tumors of the jejunum.
FIGURE 1B: Multiplanar coronal reconstruction of the abdomen and pelvis show two mesenteric masses (arrows).
CASE PRESENTATION
A 65-year-old female presented to the emergency department with abdominal pain, vomiting, and constipation. These symptoms were present for approximately one month and acutely worsened over the past four days. The sharp, periumbilical pain was exacerbated by eating and relieved by vomiting. Past medical history was remarkable for peptic ulcer disease and she denied previous surgeries, recent travel, sick contacts, or abdominal trauma. Vital signs were within normal limits. Physical exam revealed tenderness in the periumbilical region. Metabolic panel was remarkable for elevated alkaline phosphatase, mild hyponatremia, and hyperkalemia; electrocardiogram showed normal sinus rhythm. Hematologic parameters, lipase, urinalysis, and lactic acid were all within normal limits. Upright abdominal radiograph revealed multiple air fluid levels and paucity of gas within the rectum and throughout the colon. Subsequent non-contrast CT revealed two irregularly marginated solid mesenteric masses (Figure 1A, 1B) causing proximal small bowel dilatation and a collapsed small bowel loop (Figure 1C) distal to the mesenteric mass consistent with mechanical obstruction. Following resuscitation, the patient was taken urgently to the operating
FIGURE 1C: Axial noncontrast CT Image immediately distal to the previous section shows a collapsed small bowel loop (arrow) distal to themesenteric mass consistent withmechanical obstruction.
J La State Med Soc VOL 169 JANUARY/FEBRUARY 2017 15
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