[Multiple carcinoids in the midgut causing intestinal gangrene--a case report].

CASE REPORT: We report the case of multiple midgut carcinoids causing segmental intestinal ischaemia in a 77-year-old man. He was admitted to our hospital because of a 2-month history of postprandial abdominal pain with nausea / vomiting and anaemia. The extensive diagnostic examinations (blood tests, ultrasound, computed tomography, hydro magnetic resonance) did not reveal any pathological findings. The small-bowel capsule endoscopy demonstrated multiple areas of bleeding. A laparotomy showed a local ischaemia of the small bowel, a segmental resection of the jejunum / ileum was performed. There were no signs of occlusion of the mesenteric artery. The pathological examination revealed 8 carcinoids of the midgut (jejunum / ileum). Immune histology demonstrated serotonin-synaptophysin-chromogranin-producing carcinoids. The patient was re-operated because of suspected ongoing mesenteric ischaemia, but no further pathologies were found. The postoperative course was uneventful. A subsequent octreotide scan was negative for metastases.

DISCUSSION: Carcinoids may become symptomatic mimicking intestinal ischaemia. Although this coincidence is considered to be typical, it is still a rare event. The diagnosis is often delayed. EVS ("elastic vascular sclerosis") of the mesenteric artery is pathognomonic for these carcinoids but, as our case demonstrates, not mandatory. According to the literature, the stage of the disease corresponds to the extent of the intestinal ischaemia.