The complicated management of a patient following transarterial chemoembolization for metastatic carcinoid
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Open Access
Case report
The complicated management of a patient following transarterial chemoembolization for metastatic carcinoid Andrew C Pearson1, Steven Steinberg2, Manisha H Shah3 and Mark Bloomston*2 Address: 1Department of Surgery, Doctors' Hospital West, Columbus, Ohio, USA, 2Department of Surgery, Ohio State University Medical Center, Columbus, Ohio, USA and 3Division of Hematology and Oncology, Ohio State University Medical Center, Columbus, Ohio, USA Email: Andrew C Pearson - [email protected]; Steven Steinberg - [email protected]; Manisha H Shah - [email protected]; Mark Bloomston* - [email protected] * Corresponding author
Published: 25 November 2008 World Journal of Surgical Oncology 2008, 6:125
doi:10.1186/1477-7819-6-125
Received: 30 June 2008 Accepted: 25 November 2008
This article is available from: http://www.wjso.com/content/6/1/125 © 2008 Pearson et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background: Transarterial Chemoembolization (TACE) has been recognized as a successful way of managing symptomatic and/or progressive hepatic carcinoid metastases not amenable to surgical resection. Although it is a fairly safe procedure, it is not without its complications. Case presentation: This is a case of a 53 year-old woman with a patent foramen ovale (PFO) and mild pulmonary hypertension who underwent TACE for progressive carcinoid liver metastases. She developed acute heart failure, due to a severe inflammatory response; this resulted in pneumatosis intestinalis due to non-occlusive mesenteric ischemia. We describe the successful non-operative management of her pneumatosis intestinalis and the role of a PFO in this patient's heart failure. Conclusion: TACE remains an effective and safe treatment for metastatic carcinoid not amenable to resection, this case illustrates the complexity of complications that can arise. A multi-disciplinary approach including ready access to advanced critical care facilities is recommended in managing such complex patients.
Case presentation A 53 year-old woman reported progressive diarrhea, flushing, and weight loss over several years. Her medical history was significant for hypertension and seizure disorder. In December of 2006, she underwent a CT scan of the abdomen as part of a workup for abdominal pain; she was found to have a large mass in the left lobe of the liver. A biopsy was obtained which demonstrated metastatic well differentiated neuroendocrine carcinoma. Follow-up colonoscopy showed a 2.5 cm mass in her terminal ileum.
Somatostatin receptor scintigraphy showed marked bilobar hepatic uptake consistent with metastatic carcinoid but no extrahepatic metastatic disease. In March 2007, she underwent a right hemicolectomy to remove the presumed primary lesi
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