Presentation
Acute abdominal pain, right iliac fossa. Acidosis.
Patient Data
Axial CT portal phase study with oral contrast revealed:
- cecal ischemia
- metastatic liver lesions
- spiculated mesenteric partially calcified soft tissue mass (later proven to be carcinoid), causing occlusion of the right colic artery
The coronal images reveal the right colic artery and vein to be passing in to and occluded by, the carcinoid tumor. This results in the ischemic cecum seen in the right iliac fossa.
The MIP'd single images more clearly demonstrate the findings:
The top white arrow points to the right colic artery and vein.
The inferior white arrow reveals no contrast to be seen in either vessel below the lesion within the mesentery.
Final Pathology report:
Right hemicolectomy:
Malignant neuroendocrine (carcinoid) tumor of the small intestine with multiple subserosal metastases and spread to at least 2-7 mesenteric lymph nodes.
Separate large focally calcified mesenteric deposits (probable lymph nodes) replaced by metastatic tumor and partial small bowel gangrene.
Case Discussion
The patient presented with acute right iliac fossa pain and acidosis.
Additional history elicited chronic mild intermittent non-specific abdominal pain for over one year. This history of non-specific chronic abdominal pain, plus the late presentation with liver metastasis, is fairly typical for small bowel carcinoids.
The CT study revealed colonic ischemia, probable liver metastasis and a spiculated partially calcified lesion in the mesentery which was causing obstruction of the right colic artery and vein.
The patient made a good post-operative recovery and was discharged home 4-5 days later.
Case presented with: Dr Chris Hare MRCP FRCR and Mr Karkala P Pai FRCS
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