Severe gastrointestinal bleeding as an early symptom of a malignant carcinoid tumor of the small intestine

Carcinoid tumors arise from enterochromaffin or enterochromaffin-like cells that are present in the gastrointestinal tract, ovaries, and lungs. Over 9 0% of carcinoids originate in the gastrointestinal tract with the most comm on sites in order of frequency being the appendix, terminal ileum, rectum, and the remainder of the colon. Gastroduodenal and pancreatic carcinoids ar e infrequent. Carcinoid syndrome is associated with small intestine carcino ids in about 40%. Common symptoms include intermittent intestinal obstructi on with crampy abdominal pain and vomiting, and weight loss. Upper gastroin testinal bleeding with melaena or hematochezia is a relatively rare early s ymptom of patients with sma II intestine carcinoid tumors. We report on a 6 9-year-old man, treated with acenocoumarol for previous thromboembolic comp lications of hereditary protein 5 deficiency. He was admitted to hospital b ecause of an acute episode of hematochezia followed by melaena. Endoscopic evaluation of esophagus, stomach, duodenum and colonoscopy revealed no appe arent source of bleeding. Selective angiographic evaluation of mesenterial arteries showed pathologic vasculature approximately in mid jejunum. Laparo tomy revealed bleeding from a small submucosal malignant carcinoid tumor in small intestine and multiple large metastases within mesenteric tissue. Se gmental resection of smalt intestine and exstirpation of the metastatic mas ses was performed. Postoperative period was uneventful. Cytotoxic chemother apy in this adjuvant setting has not been recommended. Small intestinal car cinoid tumor has to be considered as a rare cause of gastrointestinal bleed ing with melaena or hematochezia. Nevertheless, bleeding is a relatively ra re early symptom of patients with small intestine carcinoid tumor.