RECURRING DIARRHEA AND ULTRASONICALLY THICKENED SMALL-BOWEL WALLS - WHATS THE CAUSE

A 63-year old patient was admitted because of recurring watery diarrho ea, weight loss intermittent facial flush and epigastric pain. Carcino id is supposed due to the typical clinical presentation. We excluded i nfectious diarrhoea, chronic inflammatory bowel diseases, an endemic s prue, chronic pancreatitis and Whipples's disease. We supposed also a diffuse intestinal lymphoma and a pancreatic tumor because of the demo nstration of thickened small bowel wails and multiple intestinal lymph node enlargement by imaging techniques. The demonstration of increased serotonin and hydroxyindoleacetic acid levels, the histology and a po sitive octreotidszintigram confirmed the suspected diagnosis of a meta static carcinoid tumor which belongs to the neuroendocrine tumors of t he gastrointestinal tract A therapy with the somatostatin analogue oct reotide leads to a; reduction of the diarrheal episodes and the elevat ed serotonin and hydroxyindoleacetic acid levels in this patient.