Presentation
Abdominal pain, nausea, vomiting.
Patient Data
Numerous arterially enhancing, portal venous phase hypoenhancing liver lesions.
Right lower abdominal mesenteric mass with desmoplastic reaction, calcifications, and tethering of small bowel loops and vasculature. The distal SMA and SMV lead into this mass and have poorly defined flow distally.
High grade small bowel obstruction with oral contrast in the stomach and slow admixture of oral contrast with enteric fluid distally. There is relatively ill-defined/difficult to follow transition point associated with the mass in the right lower quadrant.
Multiple peritoneal nodules in the pelvis, and few in the right paracolic gutter. Small amount of ascites.
Case Discussion
Mesenteric mass in the right lower quadrant with calcifications, desmoplastic reaction, and arterially enhancing liver metastases is characteristic of carcinoid tumor of the small bowel. The primary tumor is not seen in this case, and most commonly in the ileum.
Given the narrowing of the SMA/SMV at the level of the mass, some degree of mesenteric ischemia may also be present. This likely contributes to the degree of small bowel dilation with wall thickening.
There is peritoneal carcinomatosis, evidenced by multiple pelvic nodules.
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