Intestinale Gangrän bei multiplem Karzinoidbefall des Dünndarms--Fallbericht

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 -