Intestinale Gangrän bei multiplem Karzinoidbefall des Dünndarms--Fallbericht
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Intestinale Gangrän bei multiplem Karzinoidbefall des Dünndarms--Fallbericht. / Graunke, F; Völker, H U; Larena-Avellaneda, A; Germer, C T.
in: ZBL CHIR, Jahrgang 134, Nr. 5, 09.2009, S. 486-488.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Intestinale Gangrän bei multiplem Karzinoidbefall des Dünndarms--Fallbericht
AU - Graunke, F
AU - Völker, H U
AU - Larena-Avellaneda, A
AU - Germer, C T
N1 - (c) Georg Thieme Verlag Stuttgart-New York.
PY - 2009/9
Y1 - 2009/9
N2 - CASE REPORT: We report the case of multiple midgut carcinoids causing segmental intestinal ischaemia in a 77-year-old man. He was admitted to our hospital because of a 2-month history of postprandial abdominal pain with nausea / vomiting and anaemia. The extensive diagnostic examinations (blood tests, ultrasound, computed tomography, hydro magnetic resonance) did not reveal any pathological findings. The small-bowel capsule endoscopy demonstrated multiple areas of bleeding. A laparotomy showed a local ischaemia of the small bowel, a segmental resection of the jejunum / ileum was performed. There were no signs of occlusion of the mesenteric artery. The pathological examination revealed 8 carcinoids of the midgut (jejunum / ileum). Immune histology demonstrated serotonin-synaptophysin-chromogranin-producing carcinoids. The patient was re-operated because of suspected ongoing mesenteric ischaemia, but no further pathologies were found. The postoperative course was uneventful. A subsequent octreotide scan was negative for metastases.DISCUSSION: Carcinoids may become symptomatic mimicking intestinal ischaemia. Although this coincidence is considered to be typical, it is still a rare event. The diagnosis is often delayed. EVS ("elastic vascular sclerosis") of the mesenteric artery is pathognomonic for these carcinoids but, as our case demonstrates, not mandatory. According to the literature, the stage of the disease corresponds to the extent of the intestinal ischaemia.
AB - CASE REPORT: We report the case of multiple midgut carcinoids causing segmental intestinal ischaemia in a 77-year-old man. He was admitted to our hospital because of a 2-month history of postprandial abdominal pain with nausea / vomiting and anaemia. The extensive diagnostic examinations (blood tests, ultrasound, computed tomography, hydro magnetic resonance) did not reveal any pathological findings. The small-bowel capsule endoscopy demonstrated multiple areas of bleeding. A laparotomy showed a local ischaemia of the small bowel, a segmental resection of the jejunum / ileum was performed. There were no signs of occlusion of the mesenteric artery. The pathological examination revealed 8 carcinoids of the midgut (jejunum / ileum). Immune histology demonstrated serotonin-synaptophysin-chromogranin-producing carcinoids. The patient was re-operated because of suspected ongoing mesenteric ischaemia, but no further pathologies were found. The postoperative course was uneventful. A subsequent octreotide scan was negative for metastases.DISCUSSION: Carcinoids may become symptomatic mimicking intestinal ischaemia. Although this coincidence is considered to be typical, it is still a rare event. The diagnosis is often delayed. EVS ("elastic vascular sclerosis") of the mesenteric artery is pathognomonic for these carcinoids but, as our case demonstrates, not mandatory. According to the literature, the stage of the disease corresponds to the extent of the intestinal ischaemia.
KW - Aged
KW - Diagnosis, Differential
KW - Gangrene
KW - Gastrointestinal Hemorrhage/pathology
KW - Humans
KW - Ileal Neoplasms/pathology
KW - Ileum/blood supply
KW - Ischemia/pathology
KW - Jejunal Neoplasms/pathology
KW - Jejunum/blood supply
KW - Male
KW - Neoplasms, Multiple Primary/surgery
KW - Postoperative Complications/pathology
KW - Reoperation
U2 - 10.1055/s-0028-1098937
DO - 10.1055/s-0028-1098937
M3 - SCORING: Zeitschriftenaufsatz
C2 - 19757351
VL - 134
SP - 486
EP - 488
JO - ZBL CHIR
JF - ZBL CHIR
SN - 0044-409X
IS - 5
ER -