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April 1984

Ileal Tumor Causing Carcinoid Syndrome Without Hepatic Metastases

Author Affiliations

Hartford, Conn

Arch Surg. 1984;119(4):485. doi:10.1001/archsurg.1984.01390160107021

To the Editor.—A recent case prompted us to review accumulating evidence that carcinoid syndrome may complicate gastrointestinal carcinoid tumors in the absence of liver metastases.1,2

Report of a Case.—A 51-year-old man with several years' history of diarrhea, facial flushing, and weight loss was found to have an elevated urinary 5-hydroxyindoleacetic acid level (50 mg/24 hr). Liver function test results and liver scan were normal. Arteriography suggested an ileal carcinoid. Liver biopsy showed a few granulomas consistent with allopurinol use but no evidence of metastatic disease. At laparotomy, an enlarged mass was found in the mesentery at the middle of the ileum, with extensive lymphadenopathy extending along the superior mesenteric artery to the periaortic nodes. The liver appeared normal during careful palpation and visualization. Following resection of an ileal carcinoid and much of the mesenteric tumor, diarrhea decreased, but the urinary 5-hydroxyindoleacetic acid level remained elevated. A computed