2663 A Rare Presentation of Duodenal Carcinoid Tumor Complicated by Hemorrhagic Shock

Abstract

INTRODUCTION: A carcinoid tumor is a tumor that develops from enterochromaffin cells. These cells produce hormones and chemicals that have a profound impact on the circulatory system, gastrointestinal tract, and the lungs. Duodenal carcinoid tumors are rarely encountered in the clinical setting making up only 2–4% of all carcinoid tumors. They are also difficult to diagnose due to their nonspecific clinical presentation which include symptoms such as abdominal pain, jaundice, pancreatitis and weight loss. According to the general guidelines for the treatment of duodenal carcinoid tumors, endoscopic therapy is recommended for tumors measuring less than 1 cm in diameter, whereas surgical resection may be preferable for those measuring 1 cm or more. However, treatment guidelines for duodenal carcinoids are not yet standardized as a result of the lack of consistent data. The most feared complication of carcinoid tumors include carcinoid crisis but milder presentations may include anemia, shortness of breath and diarrhea. CASE DESCRIPTION/METHODS: A 79 year old male with a history of hypertension, hyperlipidemia, spinal stenosis, aortic stenosis and carcinoid tumor at the gastric bulb who previously refused interventional surgery presented to the hospital with a primary complaint of shortness of breath. Initial hemoglobin on presentation was 5.1 and patient noted to be in hemorrhagic shock with vital signs that included heart rate of 116 and blood pressure of 91/52. Patient was subsequently admitted to the intensive care unit and transfused a total of 6 units of packed red blood cells over the course of his 8-day hospital course. An octreotide scan performed during the hospital stay showed a carcinoid tumor at the gastric bulb that was not actively bleeding. This may be explained by the patient’s late presentation to the hospital after the carcinoid tumor bleeding had resolved. The patient at the conclusion of the hospital stay continued to decline any surgical intervention. DISCUSSION: This case highlights an unusual presentation of a patient with a history of carcinoid tumor that presented in hemorrhagic shock secondary to a duodenal carcinoid tumor. Previous research has shown complications of carcinoid tumors that range from diarrhea and shortness of breath to carcinoid crisis. However, hemorrhagic shock has not been demonstrated to be an association with carcinoid tumor. Further large scale retrospective studies may be needed to better evaluate to the full scope of carcinoid tumor complications.