Carcinoid Tumor Presenting as Recurrent Small Bowel Obstruction

Abstract

Purpose: Carcinoid tumors are rare neuroendocrine tumors with secretory properties. They are slow growing malignant neoplasms but can act aggressively. Carcinoid syndrome may manifest as a syndrome related to the secretory properties of the tumor. Symptoms of carcinoid syndrome usually consist of flushing, sweating, diarrhea and bronchospasm. Carcinoid tumors of the small intestine comprise approximately one third of small intestine neoplasms. Patients with carcinoid of the small intestine will commonly present with abdominal pain and chronic progressive bowel obstruction if they have metastases to the lymph nodes. We present a rare case of a patient with carcinoid tumor who presented with recurrent bowel obstruction. The patient is an 28 year old gentleman who presented with recurrent abdominal distension and abdominal pain. There was no history of melena, hematemesis, vomiting of feculent or bilious material, fever, chills or weight loss. He did not complain of any flushing, sweating or diarrhea. He had no significant past medical history and no prior history of abdominal surgery. The patient denied taking any medications and denied any alcohol, smoking or drug history. The patient was afebrile and had stable vital signs on admission. On physical exam, the abdomen was markedly distended with periumbilical and right lower quadrant tenderness on palpation. There was no rebound tenderness and no masses were palpable. Bowel sounds were present and were not hyperactive. Rectal examination was normal. His laboratory findings on CBC, chemistry and liver function tests were all within normal limits. An X-ray of the abdomen showed multiple air fluid levels consistent with partial small bowel obstruction. This was confirmed on CT scan, which showed distended loops of small bowel and multiple liver lesions were also noted. A liver biopsy was performed for diagnostic purposes. Pathology revealed swirls of neuroendocrine cells consistent with carcinoid tumor. The patient was managed conservatively, kept NPO and was treated with intravenous somatostatin analogues. The patient's symptoms improved and his diet was advanced and he was eventually discharged home and is currently doing well. Although carcinoid tumors are occasionally seen in the gastrointestinal tract and can present with a myriad of GI symptoms, recurrent bowel obstruction is a rare presenting finding. This case demonstrates that when a patient presents with recurrent episodes of intermittent bowel obstruction, carcinoid tumor should be considered as part of the differential diagnosis.