RESUMO
Carcinoid tumours have the ability to secrete various peptides and bioamines that lead to carcinoid syndrome manifested as cutaneous flushing, diarrhoea, bronchial constriction and cardiac involvement. The deficiencies of vitamins D and B12 have previously been reported in patients with carcinoid tumours presumably due to chronic diarrhoea associated with the carcinoid syndrome. Herein, we chronicle the case of a patient with opioid use disorder who presented with small bowel obstruction that was found to be caused by a midgut carcinoid tumour. Laboratory studies revealed deficiencies of vitamins D and B12 even though he denied diarrhoea and had no other aetiology of deficiencies of these vitamins. Additionally, this paper presents a review of the published medical literature pertaining to clinical features, diagnostic investigations and treatment of intestinal carcinoid tumours and explores possible explanations for the observed deficiencies in these patients.
Assuntos
Carcinoma Neuroendócrino/patologia , Neoplasias do Íleo/patologia , Carcinoma Neuroendócrino/complicações , Carcinoma Neuroendócrino/diagnóstico por imagem , Carcinoma Neuroendócrino/cirurgia , Humanos , Neoplasias do Íleo/complicações , Neoplasias do Íleo/diagnóstico por imagem , Neoplasias do Íleo/cirurgia , Laparotomia , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/complicações , Deficiência de Vitamina B 12/complicações , Deficiência de Vitamina B 12/diagnóstico , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/diagnósticoRESUMO
Intussusception is rare in adults. We describe a 47-year-old man with ileal schwannoma that led to ileocolic intussusception. Abdominal ultrasonography, abdominal CT scan and barium enema confirmed an ileal tumor. Colonoscopy revealed a peduncular submucosal tumor (SMT) 75 mm long with an ulcerated apex at the ascending colon. The provisional diagnosis was a gastrointestinal stromal tumor of the terminal ileum. Ileocecal resection was carried out and the tumor was histologically diagnosed as schwannoma. Abdominal pain resolved postoperatively. This case reminds us that ileal schwannoma should be included in the differential diagnosis of intussusception caused by an SMT in the intestine.
Assuntos
Neoplasias do Íleo/patologia , Intussuscepção/patologia , Neurilemoma/patologia , Colonoscopia , Diagnóstico Diferencial , Humanos , Neoplasias do Íleo/complicações , Neoplasias do Íleo/diagnóstico por imagem , Intussuscepção/diagnóstico por imagem , Intussuscepção/etiologia , Masculino , Pessoa de Meia-Idade , Neurilemoma/complicações , Neurilemoma/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: The aim of this study was to assess the diagnostic potential of multidetector computed tomography (MDCT) in the evaluation of small-bowel neoplasms. MATERIALS AND METHODS: We studied 120 patients with suspected small-bowel disease by 16-slice MDCT after oral administration of a polyethylene glycol solution (n=56) or methylcellulose via a nasojejunal tube (n=64). Unenhanced and contrast-enhanced CT was performed. Contrast-enhanced CT images were acquired 40 s after IV injection of 130 ml of iodinated contrast agent at a rate of 3 ml/s. Multiplanar reconstructions were performed at the end of the examinations. RESULTS: Fifteen patients were found to be affected by small-bowel neoplasm (six had non-Hodgkin's lymphoma, three had carcinoid tumour, two had Peutz-Jeghers syndrome, two had adenocarcinoma, two had melanoma metastases, one had lipoma). In the remaining patients, 58 cases of Crohn's disease and seven miscellaneous diseases were detected. All findings were confirmed by barium studies, surgery or endoscopy. CONCLUSIONS: MDCT performed after bowel-loop distension with low-density contrast material and IV administration of iodinated contrast agent is a reliable method for diagnosing and staging small-bowel neoplasms.
Assuntos
Adenocarcinoma/diagnóstico por imagem , Tumor Carcinoide/diagnóstico por imagem , Neoplasias do Íleo/diagnóstico por imagem , Neoplasias do Jejuno/diagnóstico por imagem , Lipoma/diagnóstico por imagem , Linfoma não Hodgkin/diagnóstico por imagem , Síndrome de Peutz-Jeghers/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adenocarcinoma/patologia , Administração Oral , Sulfato de Bário/administração & dosagem , Biópsia , Tumor Carcinoide/patologia , Distribuição de Qui-Quadrado , Meios de Contraste/administração & dosagem , Enema , Feminino , Humanos , Neoplasias do Íleo/patologia , Íleo/patologia , Processamento de Imagem Assistida por Computador , Injeções Intravenosas , Neoplasias do Jejuno/patologia , Jejuno/patologia , Lipoma/patologia , Linfoma não Hodgkin/patologia , Masculino , Metilcelulose/administração & dosagem , Síndrome de Peutz-Jeghers/patologia , Polietilenoglicóis/administração & dosagem , Intensificação de Imagem Radiográfica , Sensibilidade e EspecificidadeRESUMO
Caecal volvulus is a well described but unusual condition. We report here, a case of caecal volvulus in a 53-year-old Caucasian woman associated with intussuscepted submucous lipoma of the ileocaecal region. The imaging and pathology are presented. Submucous lipoma of the ileocaecal region is uncommon but well described. It can be mistaken as carcinoma of the ascending colon on barium enema and on computed tomography scan. The combination with caecal volvulus is a rare occurrence.
Assuntos
Doenças do Ceco/etiologia , Neoplasias do Íleo/complicações , Valva Ileocecal , Obstrução Intestinal/etiologia , Lipoma/complicações , Doenças do Ceco/diagnóstico por imagem , Feminino , Humanos , Neoplasias do Íleo/diagnóstico por imagem , Obstrução Intestinal/diagnóstico por imagem , Lipoma/diagnóstico por imagem , Pessoa de Meia-Idade , RadiografiaAssuntos
Neoplasias do Íleo/cirurgia , Intussuscepção/cirurgia , Lipoma/cirurgia , Idoso , Anastomose Cirúrgica , Sulfato de Bário , Colectomia , Enema , Feminino , Seguimentos , Humanos , Neoplasias do Íleo/complicações , Neoplasias do Íleo/diagnóstico por imagem , Intussuscepção/diagnóstico por imagem , Intussuscepção/etiologia , Lipoma/complicações , Lipoma/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
The occurrence of tumor in the small intestine is relatively rare. It has been demonstrated that lipoma of the ileum is a cause of intussusception. We report a 59-year-old man admitted to our hospital for lower abdominal pain. Diagnosis of intussusception was made by abdominal x-ray and ultrasonography. Enema contrast studies revealed ileocolic intussusception. Colonoscopy revealed a tumor with an submucosal tumor (SMT)-like head and coil-spring appearance in the ascending colon. Endoscopic ultrasonography (EUS) revealed a hyperechoic submucosal lesion with features compatible with lipoma. Subsequently, this was confirmed histopathologically after resection. To our knowledge, this is the first report of preoperative diagnosis of ileal lipoma by EUS.
Assuntos
Endossonografia , Neoplasias do Íleo/diagnóstico por imagem , Lipoma/diagnóstico por imagem , Humanos , Doenças do Íleo/etiologia , Neoplasias do Íleo/complicações , Neoplasias do Íleo/cirurgia , Intussuscepção/etiologia , Lipoma/complicações , Lipoma/cirurgia , Masculino , Pessoa de Meia-IdadeRESUMO
A 25-year-old male patient who had a brother with Crohn's disease was referred to our clinic with bloody diarrhea and crampy abdominal pain. After a plain erect abdominal X-ray, enteroclysis was performed, followed by abdominopelvic CT. Besides the radiological features of CD, both enteroclysis and CT revealed a big polypoid filling defect in the small intestine. The patient was surgically treated and the histopathology of the specimen revealed a giant fibroid polyp superimposed on CD, an extremely rare complication heretofore unmentioned in the radiology literature. In this report we discuss the role of enteroclysis in the diagnosis of complicated cases of long-standing CD. In addition, we also shed light on the importance of both enteroclysis and CT, with their complementary findings, in the radiological diagnosis of rare complicated cases of CD.
Assuntos
Doença de Crohn/complicações , Neoplasias do Íleo/complicações , Pólipos Intestinais/complicações , Intussuscepção/etiologia , Adulto , Sulfato de Bário/administração & dosagem , Meios de Contraste/administração & dosagem , Diagnóstico Diferencial , Enema , Humanos , Neoplasias do Íleo/diagnóstico por imagem , Neoplasias do Íleo/patologia , Neoplasias do Íleo/cirurgia , Pólipos Intestinais/diagnóstico por imagem , Pólipos Intestinais/patologia , Pólipos Intestinais/cirurgia , Intussuscepção/diagnóstico por imagem , Intussuscepção/cirurgia , Masculino , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: We studied the CT patterns of abdominal carcinoid tumors. MATERIAL AND METHODS: Eight patients with carcinoid tumors were examined with CT. The tumors were in the ileum (2 patients), duodenum (1), colon (1), and mesentery (4). Pathologic confirmation was obtained at surgery in all patients. The symptoms were the carcinoid syndrome in 2 patients, abdominal pain in 4, jaundice in 1 patient and a right lower quadrant mass in 1. All patients were examined with(out) i.v. contrast agent administration; 6 patients received oral contrast material and 2 were submitted to water enema, to enhance visualization of the distal ileum and colon. RESULTS: CT identified the tumor in all patients but correctly defined its site in 7 cases only. CT showed a small mass in the distal common bile duct in 1 case, which postoperative histology diagnosed as a malignant carcinoid tumor of the duodenum. The CT findings of carcinoid tumors were a rounded mesenteric mass displacing bowel loops in 4 cases, an infiltrating colonic tumor in 1 case, an apparently intracholedochal mass in 1, a large necrotic mesenteric mass in 1 case. CT showed lymph node involvement in 2 cases, but no liver metastases were found. A carcinoid tumor was diagnosed in 4 patients based on the typical CT finding of a mesenteric mass with radiating soft-tissue density bands resulting in a stellate pattern. No preoperative diagnosis was possible in some other cases because the CT patterns were aspecific and mimicked those of other lesions, namely of tumor of the distal common bile duct, adenocarcinoma of the right colon, submucosal tumor of the distal ileum, large necrotic mesenteric mass. CONCLUSIONS: CT is a useful tool in the detection of carcinoid tumors. The correct diagnosis can be made based on the characteristic CT finding of a rounded mesenteric mass. In our experience, however, carcinoid tumors may present with other CT patterns mimicking those of other tumors.
Assuntos
Tumor Carcinoide/diagnóstico por imagem , Neoplasias Duodenais/diagnóstico por imagem , Neoplasias do Íleo/diagnóstico por imagem , Mesentério/diagnóstico por imagem , Neoplasias Peritoneais/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Neoplasias do Íleo/diagnóstico por imagem , Neurofibromatoses/diagnóstico por imagem , Adulto , Sulfato de Bário , Carcinoma de Células Escamosas/patologia , Meios de Contraste , Enema , Feminino , Humanos , Estadiamento de Neoplasias , Neoplasias Primárias Múltiplas , Tomografia Computadorizada por Raios X , Neoplasias do Colo do Útero/patologiaRESUMO
Three cases of isolated inverted Meckel's diverticulum are described. In two cases an initial pathological diagnosis of small bowel lipoma was suggested. In a third case central fat was demonstrated on CT and peristalsis of the intraluminal polypoid mass was observed during US examination. In all three cases small bowel enema examination demonstrated the lesion. Correlation of the clinical, radiological and pathological features is emphasised, as this will allow the correct diagnosis.
Assuntos
Neoplasias do Íleo/complicações , Intussuscepção/complicações , Lipoma/complicações , Divertículo Ileal/complicações , Adulto , Diagnóstico Diferencial , Humanos , Doenças do Íleo/complicações , Doenças do Íleo/diagnóstico por imagem , Doenças do Íleo/patologia , Neoplasias do Íleo/diagnóstico por imagem , Neoplasias do Íleo/patologia , Pólipos Intestinais/complicações , Pólipos Intestinais/diagnóstico por imagem , Pólipos Intestinais/patologia , Intussuscepção/diagnóstico por imagem , Intussuscepção/patologia , Lipoma/diagnóstico por imagem , Lipoma/patologia , Masculino , Divertículo Ileal/diagnóstico por imagem , Divertículo Ileal/patologia , Pessoa de Meia-Idade , RadiografiaRESUMO
The clinical case of a 73-years old male who was admitted for diarrhea and loss of weight is presented. Barium enema and colonoscopy demonstrated small size polyps in the sigmoid colon, one of which had a histologic diagnosis of adenocarcinoma. Abdominal examination detected a mass in the mesohypogastrium which did not appear to be related to the previous findings. CAT and intestinal transit confirmed a second tumor in the small bowel with the histologic diagnosis of a resected specimen being melanoma.
Assuntos
Adenocarcinoma , Pólipos do Colo , Neoplasias do Íleo , Melanoma , Neoplasias Primárias Múltiplas , Neoplasias do Colo Sigmoide , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/cirurgia , Idoso , Pólipos do Colo/diagnóstico por imagem , Pólipos do Colo/cirurgia , Seguimentos , Humanos , Neoplasias do Íleo/diagnóstico por imagem , Neoplasias do Íleo/cirurgia , Masculino , Melanoma/diagnóstico por imagem , Melanoma/cirurgia , Neoplasias do Colo Sigmoide/diagnóstico por imagem , Neoplasias do Colo Sigmoide/cirurgia , Fatores de Tempo , Tomografia Computadorizada por Raios XRESUMO
The authors report a retrospective study concerning 32 cases of non Hodgkin lymphoma of the small intestine, histologically confirmed. All patients underwent digestive opacification. Ultrasonography was performed in 15 cases and CT scan was performed in 6 cases. The average age was 36 years and the sex-ratio was 3.4. The classical radiological signs described in the literature were found in our patients. The diagnosis of lymphoma was easily suggested in the presence of polymorphic and multifocal lesions, and especially the aneurysmal appearance. Abdominal sonography and computed tomography contributed to the diagnosis and also helped to relate an abdominal mass to its digestive origin, by showing a classical "sandwich" appearance.
Assuntos
Neoplasias Duodenais/diagnóstico por imagem , Neoplasias do Íleo/diagnóstico por imagem , Neoplasias do Jejuno/diagnóstico por imagem , Linfoma não Hodgkin/diagnóstico por imagem , Adolescente , Adulto , Idoso , Enema , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
Neoplasms of the upper gastrointestinal tract are generally detected by barium studies or endoscopy. Computed tomography remains the primary imaging modality for staging. Magnetic resonance imaging and endoscopic ultrasonography may also play an increasing role in evaluating these tumors.
Assuntos
Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias do Íleo/diagnóstico por imagem , Neoplasias do Jejuno/diagnóstico por imagem , Neoplasias Gástricas/diagnóstico por imagem , Sulfato de Bário , Enema , Neoplasias Esofágicas/epidemiologia , Neoplasias Esofágicas/patologia , Feminino , Humanos , Neoplasias do Íleo/epidemiologia , Neoplasias do Íleo/patologia , Neoplasias do Jejuno/epidemiologia , Neoplasias do Jejuno/patologia , Imageamento por Ressonância Magnética , Masculino , Metástase Neoplásica , Estadiamento de Neoplasias , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/patologia , Tomografia Computadorizada por Raios X , UltrassonografiaAssuntos
Hamartoma/diagnóstico por imagem , Neoplasias do Íleo/diagnóstico por imagem , Intussuscepção/diagnóstico por imagem , Sulfato de Bário , Enema , Hamartoma/patologia , Hamartoma/cirurgia , Humanos , Doenças do Íleo/diagnóstico por imagem , Doenças do Íleo/etiologia , Neoplasias do Íleo/patologia , Neoplasias do Íleo/cirurgia , Lactente , Mucosa Intestinal/patologia , Intussuscepção/etiologia , Masculino , RadiografiaRESUMO
From 1987 to 1989, 7 patients were diagnosed as having a primary lymphoma of the small bowel. The patients, 5 men and 2 women aged 14-66 years (average: 45), were studied by means of small bowel enema and CT. Using small bowel enema, our findings were: masses related to a loop, stenosis, mucosal patterns with thick, irregular, and nodular folds, and bowel walls thickening. In nearly all cases CT showed not only small bowel lesions but also mesenteric lymphadenopathy. Five of seven patients had lymphomas, 1 had IP-SID lymphoma (immunoproliferative small intestinal disease related lymphoma), and 1 had IPSID associated with a late prelymphomatous stage. The diagnosis of IPSID is very important in patients with malabsorption syndrome, which may or may not be related to alpha heavy chain disease, because IPSID may evolve into lymphoma but its prelymphomatous stage can be treated and cured. We have therefore reported the different features seen with enteroclysis and CT, comparing the results obtained in the various forms of lymphoma of the small bowel. The importance is stressed of an accurate diagnosis of IPSID forms, however uncommon in our Country.
Assuntos
Neoplasias do Íleo/diagnóstico por imagem , Neoplasias do Jejuno/diagnóstico por imagem , Linfoma/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Diagnóstico Diferencial , Enema , Feminino , Humanos , Neoplasias do Íleo/diagnóstico , Neoplasias do Jejuno/diagnóstico , Leucemia Linfocítica Crônica de Células B/diagnóstico , Leucemia Linfocítica Crônica de Células B/diagnóstico por imagem , Linfoma/diagnóstico , Masculino , Pessoa de Meia-Idade , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico por imagemRESUMO
The authors retrospectively reviewed the radiographic (double-contrast small-bowel enema) examinations of 20 patients with primitive small intestinal lymphomas. The diagnosis was histologically confirmed in all cases. The technique was very sensitive (100%) in detecting small-bowel abnormalities. On the contrary, a definite differential diagnosis was difficult to make (65%), except for 4 cases of lymphoma complicating celiac disease in which the presence of a nodular pattern and of thickened and irregular mucosal folds seemed to be highly specific. The most difficult differential diagnosis was with Crohn's disease. In all the cases with surgical confirmation (17), disease extent exactly corresponded to that suggested by small-bowel enema. Primitive small intestinal lymphoma is not radiologically distinguishable from secondary involvement during systemic lymphoma. From the analysis of radiological abnormalities, the authors observed that, different from previous reports, severe luminal narrowing was frequent, whereas "aneurysmal" dilatations of intestinal loops were never observed. CT was confirmed as the best technique for staging. Clinical implications of double-contrast enema in the diagnosis of primitive small intestinal lymphomas are discussed; radiographic patterns are reviewed.
Assuntos
Neoplasias Intestinais/diagnóstico por imagem , Linfoma/diagnóstico por imagem , Adulto , Idoso , Meios de Contraste/administração & dosagem , Neoplasias Duodenais/diagnóstico por imagem , Enema , Feminino , Humanos , Neoplasias do Íleo/diagnóstico por imagem , Neoplasias do Jejuno/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos RetrospectivosRESUMO
A case of primary non-Hodgkin's lymphoma of the terminal ileum with enterovesical fistula is reported. A 50-year-old Malay man presented with haematuria, dysuria and per-rectal bleeding. Intravenous urogram, double contrast enema and an MDP bone scintigram showed a fistulous communication between the bladder and distal ileum. At laparotomy, a large tumour attaching the terminal ileum to the dome of the bladder was found. Histopathological examination of resected small bowel revealed a diffuse histiocytic non-Hodgkin's lymphoma of the small bowel. The bladder mucosa was shown to be normal.
Assuntos
Neoplasias do Íleo/diagnóstico por imagem , Fístula Intestinal/diagnóstico por imagem , Linfoma não Hodgkin/diagnóstico por imagem , Fístula da Bexiga Urinária/diagnóstico por imagem , Humanos , Doenças do Íleo/complicações , Doenças do Íleo/diagnóstico por imagem , Neoplasias do Íleo/complicações , Fístula Intestinal/complicações , Linfoma não Hodgkin/complicações , Masculino , Pessoa de Meia-Idade , Radiografia , Cintilografia , Fístula da Bexiga Urinária/complicaçõesRESUMO
Radiological findings were evaluated in a series of 25 cases with malignant and three with benign small bowel tumours with surgical or autopsy confirmation of diagnosis. 27 patients were operated, two of them without any radiography due to 'acute abdomen'. 23 patients were examined with ultrasound, 14 with barium examination, seven with CT, four with plain films and two with angiography. Ultrasound revealed 16 (70%) out of 23 tumours, in two cases result was abnormal but the tumour was not found and in five cases no abnormality was identified. Eleven barium examinations (78%) showed signs of tumour, one showed signs of occlusion but not the tumour and in two cases no abnormality was found. The tumour was seen in six of seven cases examined with CT. Our results proved that US is useful as screening study. Barium studies are needed for exact location of the tumour and in US negative cases.
Assuntos
Neoplasias Duodenais/diagnóstico , Neoplasias do Íleo/diagnóstico , Neoplasias do Jejuno/diagnóstico , Adenocarcinoma/diagnóstico , Adenocarcinoma/diagnóstico por imagem , Adulto , Idoso , Angiografia , Sulfato de Bário , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/diagnóstico por imagem , Neoplasias Duodenais/diagnóstico por imagem , Enema , Feminino , Humanos , Neoplasias do Íleo/diagnóstico por imagem , Neoplasias do Jejuno/diagnóstico por imagem , Linfoma/diagnóstico , Linfoma/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Neurofibroma/diagnóstico , Neurofibroma/diagnóstico por imagem , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
The radiological detection of intestinal lipomas is not unusual; however, in-depth studies of their radiological features have never been carried out, so far. Eighteen cases of intestinal lipoma were observed, out of different clinical histories. Through a careful survey of these cases, the authors describe the semiological characteristics of the lipomas, which were studied with radiographic contrast examinations of the small intestine and colon. In most cases the characteristics of the mass and--when present--the even more revealing features of its pedicle allowed the identification of such expansive lesions as lipomas. In some lesions detected by means of conventional methods CT proved extremely useful in diagnosing the nature of the lipomas. Such a diagnosis is extremely useful for it allows extensive surgery to be avoided and replaced with less extensive procedures--e.g. endoscopic removal of the lesion, or no specific treatment at all.