Patient Data
Small bowel obstruction with gradual gradation of bright oral contrast to darker intraluminal contents and fecalization leading to the transition point in the upper pelvis. The fecalized segment has mild wall thickening. The bowel transitions in the ileum and is associated with a lobulated partially calcified mesenteric mass which likely narrows the adjacent mesenteric veins; there is subtle increased enhancement of the bowel wall in this location which could represent the primary tumor. Small ascites. No adenopathy or definite liver lesions.
Case Discussion
Typical findings of a small bowel carcinoid tumor resulting in obstruction. The primary finding that indicates this diagnosis is the partially calcified mesenteric mass with desmoplastic reaction. This indicates mesenteric spread of the primary tumor, which is often small and can be difficult to see (although some enhancement of the bowel wall may indicate the primary in this case). The desmoplastic reaction can narrow the mesenteric vasculature and cause congestion and thickening of the bowel wall, as is likely in this case. It is best to stage these with late arterial phase imaging as well to look for liver metastases (which are often hypervascular).