World Journal of Surgery

, Volume 29, Issue 9, pp 1139–1142

Abdominal Angina in Patients with a Midgut Carcinoid, a Sign of Severe Pathology

  • Harry de Vries
  • Rob T. M. Wijffels
  • Pax H. B. Willemse
  • René C. J. Verschueren
  • Ido P. Kema
  • Arend Karrenbeld
  • Ted R. Prins
  • Elisabeth G. E. de Vries
Article

Abstract

In 36 consecutive patients with a foregut carcinoid with extensive local tumor growth and liver metastases with a carcinoid syndrome, six patients had complaints of postprandial abdominal pain and attacks of subileus based on segmental intestinal ischemia. A diagnosis of abdominal angina was supported by a positive response to nitroglycerin in two and ischemia of the ileum demonstrated by angiography in two other patients. Complaints were reduced in all patients after surgery. Histopathology of the resected small bowel specimens showed elastic vascular sclerosis in three patients and ischemic changes in three other patients, confirming the clinical diagnosis. Resection of ischemic bowel can provide relief in patients with segmental intestinal ischemia caused by carcinoid-induced vascular sclerosis.

References

  1. 1.
    Modlin IM, Sandor A . An analysis of 8305 cases of carcinoid tumors. Cancer 1997;79:813–829CrossRefPubMedGoogle Scholar
  2. 2.
    Neary PC, Redmond PH, Houghton T, et al. Carcinoid disease: review of the literature. Dis. Colon Rectum 1997;40:349–362CrossRefPubMedGoogle Scholar
  3. 3.
    Moertel CG, Sauer WG, Dockerty MB, et al. Life history of the carcinoid in the small intestine. Cancer 1961;14:901–912PubMedGoogle Scholar
  4. 4.
    Anthony PP, Drury RA. Elastic vascular sclerosis of mesenteric blood vessels in argentaffin carcinoma J. Clin Pathol. 1970;23:110–118Google Scholar
  5. 5.
    Brada SJ, Wijffels RT, Kahraman T, et al. Sublingual nitrate provides cause for fear of food in a carcinoid patient. Ann. Oncol 1997;8:1053–1054CrossRefGoogle Scholar
  6. 6.
    Frank M, Klose KJ, Wied M, et al. Combination therapy with octreotide and alpha-interferon: effect on tumor growth in metastatic endocrine gastroenteropancreatic tumors. Am. J. Gastroenterol. 1999;94:1381–1387PubMedGoogle Scholar
  7. 7.
    Kolby L, Persson G, Franzen S, et al. Randomized clinical trial of the effect of interferon alpha on survival in patients with disseminated midgut carcinoid tumours. Br. J. Surg. 2003;90:687–693CrossRefPubMedGoogle Scholar
  8. 8.
    Wallace S, Ajani JA, Charnsangavej C, et al. Carcinoid tumors: imaging procedures and interventional radiology. World J. Surg. 1996;20:147–156CrossRefPubMedGoogle Scholar
  9. 9.
    Bessell JR, Karatassas A, Allen PW. Intestinal ischaemia associated with carcinoid tumour: a case report with review of the pathogenesis. J. Gastroenterol. Hepatol. 1994;9:304–307PubMedGoogle Scholar
  10. 10.
    Eckhauser FE, Argenta LC, Strodel WE, et al. Mesenteric angiopathy, intestinal gangrene, and midgut carcinoids. Surgery 1981;90:720–728PubMedGoogle Scholar
  11. 11.
    Harvey JN, Denyer ME, DaCosta P. Intestinal infarction caused by carcinoid associated elastic vascular sclerosis: early presentation of a small ileal carcinoid tumour. Gut 1989;30:691–694PubMedGoogle Scholar
  12. 12.
    Payne James JJ, de Gara CJ, Lovell D, et al. Metastatic carcinoid tumour in association with small bowel ischaemia and infarction. J. R. Soc. Med. 1990;83:54Google Scholar
  13. 13.
    Qizilbash AH. Carcinoid tumors, vascular elastosis, and ischemic disease of the small intestine. Dis. Colon. Rectum 1977;20:554–560PubMedGoogle Scholar
  14. 14.
    Strobbe L, D’Hondt E, Ramboer C, et al. Ileal carcinoid tumors and intestinal ischemia. Hepatogastroenterology 1994;41:499–502PubMedGoogle Scholar
  15. 15.
    Sworn MJ, Reasbeck P, Buchanan R: Intestinal ischaemia associated with ileal carcinoid tumors. Br. J. Surg. 1978;65:313–315PubMedGoogle Scholar
  16. 16.
    Warner TF, O’Reilly G, Lee GA. Mesenteric occlusive lesion and ileal carcinoids. Cancer 1979;44:758–762PubMedGoogle Scholar
  17. 17.
    La Rosa S, Chiaravalli AM, Capella C, et al. Immunohistochemical localization of acidic fibroblast growth factor in normal human enterochromaffin cells and related gastrointestinal tumors. Virchows Arch. 1997;430:117–124CrossRefPubMedGoogle Scholar
  18. 18.
    Modlin IM, Shapiro MD, Kidd M. Carcinoid tumors and fibrosis: an association with no explanation. Am. J. Gastroenterol. 2004;99:2466–2478CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2005

Authors and Affiliations

  • Harry de Vries
    • 1
  • Rob T. M. Wijffels
    • 1
  • Pax H. B. Willemse
    • 2
  • René C. J. Verschueren
    • 1
  • Ido P. Kema
    • 3
  • Arend Karrenbeld
    • 3
  • Ted R. Prins
    • 4
  • Elisabeth G. E. de Vries
    • 2
  1. 1.Department of Surgery University Medical Center GroningenGroningenThe Netherlands
  2. 2.Department of Medical OncologyUniversity Medical Center GroningenGroningenThe Netherlands
  3. 3.Department of Pathology and Laboratory MedicineUniversity Medical Center GroningenGroningenThe Netherlands
  4. 4.Department of RadiologyUniversity Medical Center GroningenGroningenThe Netherlands

Personalised recommendations