Abdominal Angina in Patients with a Midgut Carcinoid, a Sign of Severe Pathology

Abstract

In 36 consecutive patients with a foregut carcinoid with extensive local tumor growth and liver metastases with a carcinoid syndrome, six patients had complaints of postprandial abdominal pain and attacks of subileus based on segmental intestinal ischemia. A diagnosis of abdominal angina was supported by a positive response to nitroglycerin in two and ischemia of the ileum demonstrated by angiography in two other patients. Complaints were reduced in all patients after surgery. Histopathology of the resected small bowel specimens showed elastic vascular sclerosis in three patients and ischemic changes in three other patients, confirming the clinical diagnosis. Resection of ischemic bowel can provide relief in patients with segmental intestinal ischemia caused by carcinoid-induced vascular sclerosis.

Pathogenesis and Clinical Management of Mesenteric Fibrosis in Small Intestinal Neuroendocine Neoplasms: A Systematic Review

“…Importantly, the mainstay of treatment for MF in SI-NEN patients is locoregional resective surgery either with a curative intent or to provide symptomatic relief, depending on the stage of the disease ( Figure 4 ) [ 87 ]. However, compromise of the mesenteric vasculature in the root of the mesentery may render surgical resection technically challenging and endanger the circulation to substantial parts of the intestine, leading to devastating complications such as short-bowel syndrome.…”

Palliative bypass for small bowel carcinoid with mesenteric mass and vascular encasement

“…Post‐prandial abdominal pain in patients with midgut carcinoid can either be caused by intestinal obstruction or segmental ischaemia; this can be difficult to differentiate clinically . Computed tomography with arterial contrast or a selective angiography of the superior mesenteric artery may be helpful . However, it is not uncommon that a laparotomy is performed for an acute abdomen or bowel obstruction where the diagnosis is made intraoperatively, such as in the case of our patient.…”

“…The fibrotic entrapment and angulation of the involved intestinal loops can lead to bowel obstruction, while more advanced cases of mesenteric vessel encasement can lead to venous or arterial ischaemia of the segments of intestines . Post‐prandial abdominal pain in patients with midgut carcinoid can either be caused by intestinal obstruction or segmental ischaemia; this can be difficult to differentiate clinically . Computed tomography with arterial contrast or a selective angiography of the superior mesenteric artery may be helpful .…”

Abdominal Angina due to Obstruction of Mesenteric Artery Treated With Spinal Cord Stimulation: A Clinical Case

“…The most common cause of abdominal angina is the atherosclerotic vascular disease, where the occlusive process commonly involves the ostia and the proximal portion of the mesenteric vessels. It can be associated with carcinoma, aortic coarctation, and antiphospholipid syndrome (2–4). The international incidence rate of the disease is unknown and few data on the affected population are available.…”