Goblet Cell Carcinoid (GCC) of the Appendix presenting as a Small Bowel Obstruction.

A 68 year old male presented to our Emergency Department with a one-day history of right sided abdominal pain, distention and vomiting on a background of no previous abdominal surgery. Abdominal CT demonstrated a high grade, closed loop small bowel obstruction involving the terminal segment of the ileum. Also of significance was alow-density appendiceal nodule. A subsequent laparoscopy revealed the tip of the appendix adherent to the mesosigmoid colon, forming a tight band and consequent mechanical bowel obstruction. Furthermore, the meso-appendix was embedded with crystal deposits and extruding mucin. The decision was made to convert to laparotomy and perform a caecectomy. Immunohistochemistry demonstrated reactivity to synaptophysin, chromogranin A and CD56, confirming the diagnosis of Goblet Cell Carcinoid. A staging CT after this initial surgery revealed no metastasis. After discussion at our oncology MDT, the patient went on to receive a completion right hemicolectomy which revealed no further malignancy on histology. The patient otherwise progressed well, and made a good post-operative recovery.

Diarrhoea after laparoscopic cholecystectomy: incidence and main determinants.

BACKGROUND: Data on the effect of laparoscopic cholecystectomy (LC) on bowel function are controversial. The aim of this study was to determine the incidence of postcholecystectomy diarrhoea (PCD) and to identify patient characteristics that can be used as predictors in daily practice. METHODS: In 100 consecutive patients who underwent LC, data were obtained from clinical records and telephone survey 6-12 months postoperatively using standardized questionnaire. RESULTS: Postoperatively, 19 patients had diarrhoea, including 17 with new onset. Two patients with preoperative and postoperative diarrhoea were excluded from further analysis. Of 98 patients (mean age 58.1 +/- 19.4 years; 62 women) 34 were younger than 50 years, 33 were overweight (BMI 25-29.9 kg/cm(2)) and 29 were obese (BMI >30 kg/cm(2)). PCD was significantly associated with younger age (odds ratio (OR) 3.4; 95% confidence interval (CI) 1.16-9.96; P = 0.026), higher BMI (OR 1.1; 95%CI 1.01-1.18; P = 0.019) and food intolerance postoperatively (OR 3.4; 95%CI 1.18-10.08; P = 0.025). PCD was most common with combination of two or three of the following factors: age <50 years, male sex, BMI >25 kg/cm(2). The highest risk of developing PCD was observed in obese men younger than 50 (OR 26.1), and the lowest in persons aged >50 years with BMI <25 kg/cm(2) (OR = 0.8). CONCLUSION: After LC, 17% of patients reported troublesome new-onset diarrhoea. PCD was independently associated with younger age, especially <50, and postoperative food intolerance. Coexistence of age <50 with high BMI and male sex was predictive for PCD.