Carcinoid tumour of the terminal ileum - malignant obstruction with ultrasound-guided biopsy
Presentation
Abdominal discomfort
Patient Data
Small bowel obstruction involving the mid to distal ileum, with abrupt transition point in the right mid abdomen where there is associated bowel wall thickening and nodularity projecting outside of the bowel wall. Single enlarged ileocolic lymph node. No liver lesions.
Ultrasound-guided biopsy
Ileocolic lymph node biopsy was performed after resolution of the small bowel obstruction. This was performed by applying pressure to the anterior abdomen, which displaced the small bowel loops and (perhaps surprisingly) brought in the ileocolic lymph node to just under the anterior abdominal wall, reducing the distance to the target to 6-7 cm from 13 cm on the CT. These images illustrate the needle passing in to the lymph node sample.
Case Discussion
Relatively common presentation of a distal ileal carcinoid tumour, which manifests as subtle or perhaps indiscernible bowel wall thickening, with a more pronounced nodule in this case, and the more common manifestation of ileocolic adenopathy.
This case importantly illustrates the value of ultrasound compression and obtaining a biopsy of deep abdominal pelvic target safely. On the initial CT the depth of the target was about 13 cm, which was reduced to 6-7 cm with compression sonography. This could not be biopsied with CT. With ultrasound, we were able to displace the bowel providing safe passage to the target. Literature supports compression with ultrasound can reduce the distance to target by 40-50% or more.1
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