University of Puerto Rico, Medical Sciences Campus San Juan, PR
Paola Laracuente Roman, MD1, Paloma Velasco, MD2, Artemio Santiago Molina, MD1 1University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico; 2University District Hospital, San Juan, Puerto Rico Introduction:
Carcinoid tumors are rare gastrointestinal neuroendocrine neoplasms with typically indolent progression. Their indolent progression and unspecific symptoms often lead to delayed diagnosis and incidental finding during surgery or imaging.
Case Description/
Methods: This is the case of a 55-year-old male with a previous history of Fournier gangrene resulting in diverting colostomy, who presented to our institution with a 2-month history of anorexia, nausea, and persistent watery diarrhea resulting in dehydration and acute renal failure requiring multiple ER visits. A physical exam revealed a large amount of watery diarrhea on the colostomy bag. Laboratories were remarkable for impaired renal function, normal liver function tests, hypoalbuminemia, and stable normocytic anemia. Stool workup was found to be negative, including culture, C. diff toxin, fecal leukocytes, ova and parasites, and Giardia. He was treated symptomatically with loperamide and with aggressive IV hydration. Abdomen and pelvis CT with IV and PO contrast revealed a large intraluminal filling defect extending throughout the ascending colon and thickening of the bowel walls of the distal ileum; findings concerning malignancy. Colonoscopy via stoma was performed and found remarkable for a large exophytic, friable, erythematous, irregular mass at the terminal ileum occluding more than fifty percent of the lumen and precluding further advancement of the scope. Biopsies showed a well-differentiated neuroendocrine tumor; immunohistochemistry was found to be chromogranin and synaptophysin positive, diffuse, and strong. Additionally, with a ki67 labeling index of less than 2 percent. Further imaging for staging purposes was consequently performed and no evidence of metastatic disease was found. General surgery was consulted and ileocecectomy with primary anastomosis and colostomy takedown was planned, however, the patient had a prolonged hospitalization complicated with multiple nosocomial infections leading to marked clinical deterioration and ultimately to his death.
Discussion: Although carcinoid tumors are rare, they can present as persistent chronic diarrhea, often leading to misdiagnosis. Due to their uncommon nature clinicians must maintain a high index of suspicion as thinking beyond the usual suspects of chronic diarrhea can make the difference between delayed discovery and early, life-changing treatment.
Disclosures: Paola Laracuente Roman indicated no relevant financial relationships. Paloma Velasco indicated no relevant financial relationships. Artemio Santiago Molina indicated no relevant financial relationships.
Paola Laracuente Roman, MD1, Paloma Velasco, MD2, Artemio Santiago Molina, MD1. P1939 - When Diarrhea Persists: An Unusual Presentation of Terminal Ileum Carcinoid Tumor, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
