Shaista Salman, Asim M. Hamed Almughamsi
Am J Case Rep 2008; 9:379-381
Background: Carcinoid tumors of the gastrointestinal tract are extremely rare and frustrate the physicians by their complex symptoms and varied biochemical affections. The tumors constitute a unique pathological entity and the diagnosis is almost always established post operatively.
Case Report: A 27-year-old female presented with excruciating right lower abdominal pain of one day duration. The abdominal examination revealed a soft, lax abdomen with guarding in the right iliac fossa without abdominal defense. Apart from a leukocytosis of 18.3/mm3, the rest of her baseline investigations and imaging including abdominal X-rays, abdominal and pelvic ultrasound and abdominal CT scan were unremarkable. Patient’s persistent pain prompted the treating surgeon to perform appendectomy which disclosed an inflamed Meckel’s diverticulum and a normal looking appendix. Meckel’s diverticulectomy along with appendectomy was performed. The histological report showed carcinoid tumor in the Meckel’s diverticulum with free resection margins whereas appendix was reported to be normal.
Conclusions: Atypical presentation and rarity of the carcinoid tumors necessitates a high index of suspicion. Surgery is the treatment of choice and, despite an excellent prognosis, all reported patients with carcinoid tumors should be followed up with urinary 5- HIAA and abdominal ultrasonography.
Keywords: Meckel’s diverticulum, 5-hydroxyindole acetic acid, carcinoid tumors, carcinoid syndrome