Small Bowel Carcinoids: A Single Surgeon's Experience in Southern India.

Abstract

Small bowel carcinoid tumours are indolent neuroendocrine tumours usually seen in the 6(th) and 7(th) decades. Most often, they are silent with non-specific symptoms. They generate serotonin, provoking a desmoplastic reaction in the mesentery leading to bowel ischemia and obstruction. While CECT abdomen can help raise suspicion and show regional spread, elevated 24-hour urinary 5-HIAA levels, histopathology and immunohistochemistry for Chromogranin A are confirmatory. To analyse a single surgeon's experience of clinical features and diagnosis of carcinoid tumours of the small intestine. Retrospective study conducted at MS Ramaiah Medical College and Hospital, Bangalore, India. Fourteen cases of carcinoid of the small bowel presenting to our institution over a 9-year period between December 2005 and November 2014 comprised the study. This included 10 males to 4 females aged 43 to 67 years (Mean: 54.4 years). The patients were investigated using x-ray abdomen, barium study, CECT abdomen, colonoscopy and 24-hour urinary 5- HIAA levels. All patients were surgically treated and histological examination of the resected tumours and immunohistochemistry for Chromogranin A was performed. Twelve patients with ileal carcinoids presented with long standing intestinal colic and sub-acute obstruction. Two patients with jejunal carcinoids had epigastric pain. X-ray abdomen was suggestive of small bowel obstruction in 12 patients. CECT abdomen done in 6 patients, showed ileal narrowing causing proximal dilatation; and cocooining of ileal loops at ileo-caecal junction in 2 cases. Ten patients underwent segmental resection-anastomosis of the tumour-bearing intestine while 4 patients underwent a right hemicolectomy. Lymph node spread was seen in 8 patients of whom 4 had liver metastases. Histopathology and Chromogranin A positivity confirmed the diagnoses. Postoperatively, 24-hour urinary 5-HIAA was mildly elevated in 2 patients. 12 patients were disease free at mean follow up of 4.3 years. 2 patients died due to inanition at 3 and 5 months postoperatively. Carcinoid tumours of small intestine are uncommon in southern India. But they should be considered as differential diagnosis when intestinal tuberculosis is suspected in the elderly presenting with intestinal colic or sub-acute obstruction. They are associated with good prognosis after adequate resection.