A Patient with Multiple Gastrointestinal Carcinoid Tumours P
A 49-year-old male with adult-onset bronchial asthma, on inhalers for the past 5 years, presented with sudden onset severe epigastric pain for a 1-day duration. He denied any history of nausea, vomiting, abdominal distension, or a recent change in bowel habits. He has been having similar episodes for the past 2 months and was managed as “gastritis” with proton pump inhibitors. Physical examination revealed a soft, non distended abdomen, with mild generalized tenderness. Biochemical and hematological investigations were within normal limits.

An ultrasound scan revealed a small bowel intussusception with the classical target sign. Contrast-enhanced computed tomography (CECT) of the abdomen revealed a large segment proximal bowel intussusception, with two intra-abdominal masses with prominent arterial enhancement, attached to the proximal mesentery. The combination of recent-onset asthma and the highly suggestive radiological findings raised the suspicions of a carcinoid tumor. Therefore, serum chromogranin A level was also performed.

The patient underwent an exploratory laparotomy. A proximal jejunal intussusception was identified which was easily reducible. There were three benign-looking tumors, two arising from the proximal small bowel mesentery and a third one arising from the proximal jejunal wall which was the leading point for the intussusception. The two mesenteric tumors were excised with the vascular pedicle supplying the tumors. The tumor arising from the proximal jejunum was excised with a 1?cm cuff of normal bowel tissue and repaired primarily. The rest of the peritoneal survey was normal, and there was no evidence of liver deposits. Histopathological analyses of all 3 tumors revealed a Grade 1 carcinoid tumor of classic type. The Ki-67 proliferation index was less than 1%. The postoperative period was uncomplicated, and the patient was discharged on day 3. Serum chromogranin A levels that were sent before surgery were high. At 3 months after surgery, serum chromogranin levels were 64.5. At 6 months of follow-up, the patient was completely asymptomatic and was free of asthmatic episodes.