Introduction: Carcinoid tumors are included in the neuroendocrine tumor family. They are usually seen in the gastrointestinal tract and are asymptomatic unless liver metastases are present.
Case Report: A 44-year-old male patient was admitted with chronic crampy abdominal pain, diarrhea, and redness of the face and neck. He was admitted to the emergency department for abdominal pain many times before and was hospitalized in the general surgery department with the diagnosis of ileus. Abdominal CT and MRI enteroclysis were performed, metastases in the liver, increased wall thickness in the intestinal loops in the inferior of the umbilicus, and dilatation compatible with the intraperitoneal adenopathies and proximal ileus were observed. Biopsy taken from the mass in the liver was reported as neuroendocrine metastasis. In the patient who was found to have 25-fold higher 5-HIAA levels in the urine for 24 hours, systemic octreotide LAR 30 mg was started, considering carcinoid syndrome. Gallium 68 PET-CT was performed and Intense increased activity uptake in the small intestine segment at the level of the umbilicus was evaluated in favor of a possible primary focus. Multiple metastases in the liver and one metastasis in the sacrum were detected. After the first dose of octreotide treatment, the complaints of redness partially regressed, but the abdominal pain continued and gradually increased. Oral intake was stopped, but the patient whose abdominal pain did not regress was taken to an emergency operation. Widespread implants were seen in the peritoneum and omentum during A mass causing shrinkage in the small intestine mesos at 150 cm from the ligament of Treitz. It was observed that blood supply was impaired in the intestinal loops up to the middle part of the ascending colon. Necrosed areas were excised. After the operation, the complaint of pain regressed, and he was discharged with enteral nutrition solution supplementation.
Conclusion: It was thought that the patient developed mesenteric ischemia, possibly secondary to the substances released, or with a fibrotic structure that may occur in the mesentery. Although abdominal pain and diarrhea are seen in carcinoid syndrome, other causes of abdominal pain should also be reviewed.
13 May 2023 - 16 May 2023