Malignant small bowel obstruction - carcinoid/neuroendocrine tumor

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).

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