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Histopathology. Biopsies from distal ileum polyps showed low-grade neuroendocrine pathology consistent with carcinoid tumor (hematoxylin and eosin stain; magnification x 400).
Source publication
We reported a case of multifocal carcinoid tumor of small intestine causing chronic obscure gastrointestinal bleeding, suspected on capsule endoscopy and diagnosed on double balloon enteroscopy.
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Background/aims:
Small bowel malignancies often present a diagnostic challenge due to their relative rarity and nonspecific clinical symptoms. However, technical developments in endoscopic instruments, including video capsule endoscopy (VCE) and enteroscopy, have allowed for the visualization of the entire small bowel. This study aimed to investig...
A 25-year old Ghanaian woman presented with a 1-week history of fatigue and breathlessness. Menstrual and dietary histories were normal, there was no overt gastrointestinal blood loss, and she took no medication. Physical (including digital rectal) examination was normal, apart from pale conjunctivae. Investigations revealed hae-moglobin 4.6g/dL, w...
Background
The malignant tumors of the small bowel are relatively rare, and their pre-operative diagnosis is usually difficult
Aims
This study was aimed to investigate the clinical characteristics of patients with malignant small bowel tumors who underwent double balloon enteroscopy. Secondary end points were to evaluate the usefulness and safety...
Objective: Gastrointestinal bleeding is one of the surgical emergencies that is routinely
visited in emergency departments. Although most of these patients are managed with
endoscopic modalities, some of them are managed with surgical interventions. Most of
emergency surgical interventions are done via laparotomy. With evolution in minimal
invasive...
Introduction and aims
Double-balloon enteroscopy is a recently introduced endoscopic method that enables complete visualization of the small bowel, as well as biopsy sampling and therapeutic interventions in that part of the intestine. The aim of the present study was to describe the experience acquired at our hospital to determine the characterist...
Citations
... Our case highlighted variability in the diagnosis of NET presenting with OGIB. Hernandez et al. reported small bowel NET causing OGIB, later diagnosed using DBE [14]. Dutta et al reported another case of small bowel NET, diagnosed during emergency laparotomy despite normal colonoscopy 6 months prior [15]. ...
Introduction
Undiagnosed gastrointestinal bleeding may originate in the small bowel. This presents a diagnostic challenge despite the advancement in contemporary imaging. We report two cases which highlight the limitations of routine investigation for obscure gastrointestinal bleeding.
Presentation of case
Patient A presented with a history of rectal bleeding, treated with interventional embolisation of caecal angiodysplasia. A diagnosis of neuroendocrine tumour (NET) was reached two years after presentation following intraoperative right hemicolectomy resection of a presumed recurrent angiodysplastic bleed. Patient B presented with recurrent melaena labelled as non-steroidal anti-inflammatory drug (NSAID) induced gastritis. After multiple endoscopic and radiological investigations, a 4.5 cm mass was visualised on imaging after three years, which was histologically proven as gastrointestinal stromal tumour (GIST) of the small bowel. Both patients experienced a delayed diagnosis despite multiple investigations and careful follow-up.
Discussion
Our case series discusses the benefits and limitations of investigation for gastrointestinal bleeding and suggests a need for continued multidisciplinary input in situations where the patient presumed diagnosis remains in question.
Conclusion
OGIB remains a diagnostic challenge and is attributable to small bowel pathology in 75% of cases. This suggests a need for continued investigation in situations where the patient presents multiple times despite adequate treatment for the presumed underlying condition.
The incidence of carcinoid tumor in the small intestine is increasing; however, its preoperative diagnosis is difficult. We recently experienced three cases of multiple carcinoid tumors in the small intestine successfully detected using capsule endoscopy (CE), followed by a pathological diagnosis using double-balloon enteroscopy (DBE). To diagnose multiple carcinoid in the small intestine appropriately, we reviewed the information of five cases reported to date along with our three recent cases. The literature review demonstrated that CE and DBE are useful for detecting and diagnosing small intestinal carcinoids and tumor multiplicity, which aids in determining the appropriate resection range.
