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Query: UMLS:C0021933 (intussusception)
 3,822 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Carcinoid of the small intestine, usually found in the terminal ileum, presents a diagnostic challenge when the classic clinical and laboratory findings are absent. The commonest symptom, marked abdominal pain due to intussusception, may arouse suspicion of carcinoid. The precise preoperative diagnosis in the absence of the classic syndrome is impossible and the only way to diagnose it is by colonoscopic biopsy of the terminal ileum. The case described illustrates such a preoperative diagnosis in a 59-year-old woman with severe abdominal pain, nausea, vomiting and weight loss. X-ray studies aroused suspicion of tumor intussusception as the cause of the intestinal obstruction. Colonoscopic biopsy revealed the presence of a carcinoid tumor. However, there had been no symptoms of the carcinoid syndrome, nor was there increased urinary 5-hydroxy indoleacetic acid. On operation the tumor was found to be disseminated and unresectable, so surgical intervention was limited to palliative ileo-transversostomy.
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PMID:[Preoperative diagnosis of carcinoid of the terminal ileum in the absence of carcinoid syndrome]. 247 74

The radiological diagnosis and interventional management of neuroendocrine tumours of the gastrointestinal tract and pancreas are challenging, demanding the complete gamut of available resources. Carcinoid tumours are most commonly found in the appendix and small bowel. Barium studies usually disclose a small solitary mucosal or submucosal mass in the distal ileum at times associated with smooth muscle hypertrophy and thickening of the mucosal folds. Intussusception and bowel obstruction may be the presenting finding. Mesenteric involvement may evoke a desmoplastic reaction with rigidity, fixation, angulation and tethering of small bowel loops. Angiography may demonstrate a hypervascular primary neoplasm but more frequently reveals vascular encasement and distortion from the mesenteric desmoplastic reaction. Pancreatic islet cell tumour is best defined radiologically by angiography and computed tomography as a well circumscribed hypervascular mass which enhances with contrast material. Portal venous sampling is of considerable assistance in localizing insulinoma. Metastases from neuroendocrine tumours to lymph nodes and to the liver are usually hypervascular. In the evaluation of the liver by CT scanning prior to contrast as well as dynamic scanning during the bolus intravenous injection of contrast material are necessary. At times the precontrast scan is more revealing. Computed tomography with the catheter in the superior mesenteric artery followed by selective hepatic arteriography is the most accurate combination for the detection of hepatic metastases. Interventional radiological management by sequential hepatic arterial embolization is the treatment of choice for multiple hepatic metastases from neuroendocrine tumours. Thus far, the maximum number of embolic episodes in a single patient has been 13. The carcinoid syndrome has been controlled in 87% while 79% of islet cell tumour hepatic metastases have responded. Contraindications to HAE includes a combination of all of the following: (i) replacement of more than 50% of the liver by tumour, (ii) serum lactic dehydrogenase above 425 mU/ml, (iii) serum glutamic oxaloacetic transaminase above 100 mU/ml, and (iv) bilirubin above 2 mg/dl. In the face of occlusion of the portal vein by intravascular neoplasm, HAE is contraindicated only if portal flow through collateral vein is away from the liver.
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PMID:Gastrointestinal and pancreatic endocrine tumours. 267 21