A Case of Carcinoid Likely Causing Jejunal Intussusception

A 34-year-old female was admitted to Emergency Department with an abrupt onset of diffuse abdominal pain. A CT scan done prior to her transfer revealed significant dilated loops of bowel as well as multiple target signs with likely torsed bowel. The patient consented to an exploratory laparotomy. During surgery, the proximal jejunum was found to be intussuscepted, a rare finding in an adult. There was evidence of mesenteric foreshortening throughout the small bowel and multiple whitish lesions within the mesentery, both consistent with the desmoplastic response that is characteristic of carcinoid. The interest for this case report comes from the patient’s surgical findings of jejunal intussusception as well as her extensive history, which includes a bowel resection with an ileocolic anastomosis for presumed ischemia and a carcinoid tumor in the stomach which had been removed endoscopically. 1. Background Carcinoid disease is known for its wide array of signs, symptoms, and ubiquitous gastrointestinal involvement. Carcinoid tumors are neuroendocrine in origin. The clinical presentation of the tumor depends on its location and most tumors are asymptomatic. In patients who are symptomatic, forty percent will present with abdominal pain. This may be due to intussusception, mesenteric ischemia, or a mechanical obstruction caused by the tumor [1]. The prevalence of carcinoid tumors is 1-2 cases per 100,000 persons, slightly more common in African Americans, with twenty-five to thirty-five percent arising in the small bowel (most commonly in the ileum, 91%) [2]. Carcinoid is positively associated with age, BMI, and postmenopausal women on hormone therapy [3]. Patients that present with symptoms of carcinoid syndrome, by definition, have metastasis of the tumor to the liver, and the prognosis for this select group of people is poor. Carcinoid syndrome occurs due to the release of secretory products such as serotonin, bradykinin, and histamine into the blood stream. The liver normally metabolizes these products, but this process is bypassed once it is involved. This causes signs similar to serotonin syndrome, including diarrhea, cutaneous flushing, and bronchospasm. 2. Case Presentation A 34-year-old female was transferred from an outside hospital with a sudden onset of diffuse abdominal pain. Her history is significant for malrotation with subsequent volvulus, small bowel resection done for ischemic bowel, carcinoid tumor of the stomach, multiple gastric ulcers, and a tubular adenoma of the colon. She first presented in 2005 with suspected ischemic bowel, which