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World Journal of Surgery

Published in:

01-06-2010

Stenting of the Superior Mesenteric Vein in Midgut Carcinoid Disease with Large Mesenteric Masses

Authors: Per Hellman, Ola Hessman, Göran Åkerström, Peter Stålberg, Joakim Hennings, Martin Björck, L.-G. Eriksson

Published in: World Journal of Surgery | Issue 6/2010

Abstract

Background

Midgut carcinoid (MGC) tumors generally develop in the small intestine and in >50% of cases also present with lymph node metastases in the mesentery. The majority of these tumors are surgically resectable, but a fraction are inoperable and may cause obstruction of the superior mesenteric vein (SMV), often associated with stasis of the intestinal wall and severe symptoms. These symptoms include severe abdominal pain, attacks of diarrhea, and malnutrition.

Methods

Seven patients with severe MGC including a large fibrotic inoperable mesenteric mass and severe symptoms were studied. After an obstructed SMV and signs of venous stasis in the small intestine were demonstrated, an expandable stent was inserted after puncturing an intrahepatic portal venous branch. The associated venography, patient symptoms, and radiological signs on computed tomography (CT) scans were evaluated.

Results

Four patients demonstrated resolution of their symptoms. In one patient who had intra-abdominal lymph leakage/chyloperitoneum, a complete normalization of the circulation followed and the intra-abdominal lymph leakage stalled. The venographies demonstrated normalization of the venous blood flow through the SMV, and CT scans demonstrated reduction in the thickness of the intestinal wall. In two cases there were no changes in the symptoms, and in one case a slight worsening of the symptoms ensued. In general, reductions of symptoms were associated with the degree of normalization of venous blood flow.

Conclusions

We conclude that in selected patients with MGC stenting of the SMV may improve symptoms.

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Title: Stenting of the Superior Mesenteric Vein in Midgut Carcinoid Disease with Large Mesenteric Masses
Authors: Per Hellman
Ola Hessman
Göran Åkerström
Peter Stålberg
Joakim Hennings
Martin Björck
L.-G. Eriksson
Publication date: 01-06-2010
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 6/2010
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-009-0361-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Stenting of the Superior Mesenteric Vein in Midgut Carcinoid Disease with Large Mesenteric Masses

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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