A case of abdominal angina

Abstract

Objective: In this case the authors want to enhance abdominal angina as an uncommon manifestation of a rare type of carcinoma, whose incidence has been increasing. Methods: Review of the patient's clinical record and Pubmed research using the keywords neuroendocrine carcinoma, abdominal angina, mesenteric ischemia, and intestinal obstruction. Results: A 61 year-old African woman arrived at the emergency department with abdominal colic pain in the inferior abdominal quadrants. She reported that in the last months this pain worsened after meals and relieved with fasting and, in the previous 3 days, she felt a sudden aggravation associated with constipation. The physical exam revealed no other alteration beside a mild painful abdomen. Laboratory findings consisted in leucopenia and a negative C reactive protein. Weeks before her hospital admission, she had undergone endoscopic exams that didn't reveal any significant changes. At the emergency department she underwent an abdominal CT which showed aspects compatible with mesenteric ischemia (though, inflammatory features couldn't be excluded) at the ileocecal and ascending colon level, with a coexisting mesenteric mass with 15 × 24 mm contacting directly, without apparent cleavage line, the superior mesenteric artery, which could correspond to an adenomegaly or neoplasic lesion. She was admitted to the Internal Medicine ward with the hypothesis of inflammatory bowel disease. Despite medication with mesalamine, the patient condition continued to degrade and evolved to intestinal obstruction. An emergent laparotomy was performed and several necrosed ileum loops were found twisting around the mesenteric mass. The histological exam of the surgical piece individualized a nodule corresponding to neuroendrocrine carcinoma. The immunocytochemical study was positive to chromogranin. The patient is nowadays in Oncology follow-up, which revealed negative for other neuroendrocrine tumors or metastasis. Conclusions: The neuroendrocrine tumours originate from the neuroendrocrine cells along the gastrointestinal, bronchopulmonary and genitourinary tract. They comprise 1.25% of overall malignancies and their prevalence has been increasing in the last years. Ileum neuroendocrine tumours have an incidence of 4.06/100,000.