Sigmoid Colon Perforation during Colonoscopy in a Case of Carcinoid Tumor

Document Type : Case Report

Authors

1 Department of Internal Medicine, School of Medicine, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran

2 Department of Medical Basic Sciences, School of Medicine, Bam University of Medical Sciences, Bam, Iran

Abstract

Background: Carcinoids tumors are slow-growing tumors which originate mainly from the small intestine and can produce biogenic peptides and amines. These products could cause carcinoid syndrome, and also, fibrosis in the peritoneum and mesentery.
Case report: A 50-year-old man complaining of lower limb edema, ascites, and weight loss presented for evaluation. CT scan of the abdomen and pelvis revealed liver enlargement and the increased thickness of cecum and terminal ileum. The patient consented to an exploratory colonoscopy, which led to laparotomy resulting from sigmoid colon perforation. Large retroperitoneal fibrosis developing with colon and mesentery of sigmoid was found during surgery. Hepatomegaly with microscopic tumoral infiltration of the liver was observed and diagnosis of metastatic carcinoma in the liver was confirmed by pathological examination.
Conclusion: The most common sites of primary carcinoid tumors are appendix, ileum, and cecum. One of the less common manifestations of carcinoid tumors is fibrotic reactions around or beyond the tumor that in the reported patient, there was a very extensive fibrosis in the mesentery and peritoneum and serosa covering the colon and intestines, which presented with edema of the lower extremities because of the pressure on the IVC and with perforation of the colon during colonoscopy.

Keywords


  1. Veenhof CH, de Wit R, Taal BG, Dirix LY, Wagstaff J, Hensen A, et al. A dose-ascalation study of recombinant interferon- alpha in patient’s metastatic carcinoid tumor. Eur J Cancer 1992; 28(1):75-8. doi: 10.1016/0959-8049(92)90389-j.
  2. Modlin IM, Lye KD, Kidd M. A 5-decade analysis of 13715 carcinoid tumors. Cancer 2003; 97(4):934-59. doi: 10.1002/cncr.11105.
  3. Soga J, Tazawa K. Pathologic analysis of carcinoids. Histologic reevaluation of 62 cases. Cancer 1971; 28(4):990-8. doi: 10.1002/1097-0142(1971)28:4<990::aid-cn cr2820280424>3.0.co;2-k.
  4. Modlin IM, Sandor A. An analysis of 8035 cases of carcinoid tumors. Cancer 1997; 79(4):813-29. doi: 10.1002/(sici)1097-0142(19970215)79:4<813::aid-cncr19>3.0.co;2-2.
  5. Modlin IM, Shapiro MD, Kidd M. Carcinoid tumors and fibrosis: an association with no explanation. Am J Gastroenterol; 99(12):2466-78. doi: 10.1111/j.1572-0241.2004.40507.x.
  6. Panzuto F, Nasoni S, Falconi M, Corleto VD, Capurso G, Cassetta S, et al. Prognostic factors and survival in endocrine tumor patients: comparison between gastrointestinal and pancreatic localization. Endocr Relat Cancer 2005; 12(4):1083-92. doi: 10.1677/erc.1.01017.
  7. Dasari A, Shen C, Halperin D, Zhao B, Zhou S, Xu Y, et al. Trends in the incidence, prevalence, and survival outcomes in patients with neuroendocrine tumors in the United States. JAMA Oncol 2017; 3(10):1335-1342. doi: 10.1001/jamaoncol.2017.0589.
  8. Klimstra DS, Modlin IR, Coppola D, Lloyd RV, Suster S. The pathologic classification of neuroendocrine tumors: a review of nomenclature, grading, and staging systems. Pancreas 2010; 39:707-12. doi: 10.1097/MPA.0b013e3181ec124e.
  9. Druce MR, Bharwani N, Akker SA, Drake WM, Rockall A, Grossman AB. Intra-abdominal fibrosis in a recent cohort of patients with neuroendocrine ('carcinoid') tumours of the small bowel. QJM 2010; 103(3):177-85. doi: 10.1093/qjmed/hcp191.
  10. Campos S, Amaro P, Portela F, Sofia C. Iatrogenic perforations during colonoscopy in a portuguese population: a study including in and out-of-hospital procedures. GE Port J Gastroenterol 2016; 23(4):183-90. doi: 10.1016/j.jpge.2016.02.007.
  11. Lohsiriwat Colonoscopic perforation: Incidence, risk factors, management and outcome. World J Gastroenterol 2010; 16(4):425-30. doi: 10.3748/wjg.v16.i4.425.
  12. Kalantari Khandani B, Shafieipour S, Mobasserfar A, Zahedi M.J, Hashemi M, Hayatbakhsh Abbasi M.M, Darvish Moghadam S. Evaluation of rs37464444 Polymorphism of miR-499 Gene in Patients with Colon Cancer Compared with Healthy Subjects. Journal of Kerman University of Medical Sciences, 2020; 27 (3): 204-212. doi:  22062/JKMU.2020.90639
  13. Zahedi M.J, Sharifi M, Darvish Moghadam S, Sayedmirzaee SD, Hayatbakhsh MM, Ahmadi B, Shafieipour S. Polyp Detection Rate in Performed Colonoscopies in Afzalipour and Mehregan Hospitals of Kerman. Journal of Kerman University of Medical Sciences, 2021; 28(3): 311-318. doi: 10.22062/JKMU.2021.91673