Abstract
BackgroundCarcinoid tumours are well-differentiated neuroendocrine tumours with secretory properties. Although fairly rare, they are the most common malignancy seen to affect the distal small bowel. Presentation is often non-specific with symptoms mimicking those of irritable bowel syndrome. Given this, the condition is often diagnosed late following disease progression, by which time the prognosis is poor.Case presentationA 74 year old Caucasian lady presented with a two week history of loose stools, nausea and one episode of vomiting. This sub-acute presentation occurred on a background of a four year history of intermittent abdominal pain and bloating, previously diagnosed as irritable bowel syndrome. CT scans identified dilated loops of small bowel proximal to a spiculated mass in the region of the terminal ileum. This ileal lesion was removed at laparotomy and identified as a carcinoid tumour.ConclusionThis case highlights the issue of misdiagnosis of intestinal malignancy as the benign condition of irritable bowel syndrome. There have been several other references to this happenstance in the literature, and the problem is reflected in the percentage of patients with widespread disease at the time of diagnosis. Prognosis in this condition can be dramatically improved with early diagnosis, and surgical management at this stage is often curative. For this reason it is imperative to keep this differential diagnosis in the back of one's mind when assessing patients presenting with symptoms of intermittent partial bowel obstruction. The clinical presentation of this tumour, along with investigation and management of these cases, is discussed here.
Highlights
Carcinoid tumours are well-differentiated neuroendocrine tumours with secretory properties
This case highlights the issue of misdiagnosis of intestinal malignancy as the benign condition of irritable bowel syndrome
There have been several other references to this happenstance in the literature, and the problem is reflected in the percentage of patients with widespread disease at the time of diagnosis. Prognosis in this condition can be dramatically improved with early diagnosis, and surgical management at this stage is often curative
Summary
Despite the rarity of this condition, carcinoid tumours are the most common lesion seen to affect the distal small intestine. In the majority of cases presentation is often late in the disease and metastases are regularly seen at the time of diagnosis. Given that the clinical presentation is often with non-specific abdominal symptoms, diagnosis can be difficult and patients are frequently misdiagnosed with irritable bowel syndrome [1]. Surgical resection is the only curative management option and there is evidence to support a better prognosis when lesions are small. It is important to keep this differential diagnosis in the back of one's mind when assessing patients presenting with symptoms of intermittent partial bowel obstruction to improve early diagnosis and outcomes in this patient group. Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal
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