Mesenteric carcinoid with small bowel ischaemia
Several weeks of increasing abdominal pain, much worse in last 3 days. Tender all over. Raised inflammatory markers.
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CT abdomen and pelvis
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There are numerous loops of abnormal small bowel with low density mural thickening, with mistiness and congestion of the associated mesentery. A 4 cm soft tissue density mass is present just right anterolateral to the aortic bifurcation. A few small specks of calcification are present within, with several smaller nodules in the fat around it. The superior mesenteric artery and vein are encased and occluded by this mass. No suspicious liver lesions on this portal venous phase study. A moderate volume of free fluid is present.
The mesenteric soft tissue mass exhibits typical characteristics of a carcinoid tumour - it exerts a desmoplastic reaction and caused drawing in of the adjacent mesentery and small bowel loops, and it encases and occludes the mesenteric vessels and thereby caused a mixed arterial and venous ischaemia of the affected bowel loops. In cases such as this, the mesenteric mass is usually a deposit from a lesion originating in the small bowel that may not be detected. Metastases in the liver are typically hypervascular and optimal detection requires an arterial phase CT to be acquired. Analysis of the surgical specimen confirmed carcinoid.