International Journal of Basic and Applied Medical Sciences ISSN: 2277-2103 (Online) An Online International Journal Available at http://www.cibtech.org/jms.htm 2013 Vol. 3 (3) September-December, pp.65-69/Sabina et al. Case Report 65 SMALL BOWEL CARCINOID - A RARE CAUSE OF RECURRENT SMALL BOWEL OBSTRUCTION Sabina Khan 1 , *Musharraf Husain 2 , Mohammad Jaseem Hassan 1 and Shabnam Bashir 2 1 Department of Pathology, HIMSR, Jamia Hamdard 2 Department of Surgery, HIMSR, Jamia Hamdard *Author for Correspondence ABSTRACT Carcinoids are less aggressive malignant growths arising in organs derived from the embryonic foregut, midgut or hindgut. They are rare tumors of the gastrointestinal tract but most common primary tumor of small bowel. Barring the typical carcinoid syndrome, the symptoms are often vague & atypical, and vary widely. Among the commonly reported symptoms are anorexia, weight loss, bleeding, abdominal pain and mass. However, majority of carcinoid tumours are diagnosed late because of the non-specificity of complaints. We here report a similar instance of small intestinal carcinoid who presented with features of recurrent intestinal obstruction resulting in delayed diagnosis. Key Words: Carcinod, Small Bowel Obstruction, Terminal Ileum INTRODUCTION Carcinoid term was first applied to hormonally active tumor by Oberndorfer in 1907. It follows a more benign clinical course than most other malignancies. Approximately 85% of carcinoid tumors arise in the gastrointestinal tract, the commonest site being the appendix (50%) followed by the small intestine in 3% of patients (Bader et al. 2001 and Maglinte 2001). Carcinoid of the small intestine is the most common distal small bowel malignancy. Patients with midgut carcinoids frequently have symptoms for long periods before a specific diagnosis is made. I n these patients, early diagnosis can potentially lead to a cure by surgical resection of the primary tumor. The most common signs and symptoms of an intestinal carcinoid are abdominal pain, palpable abdominal mass and intermittent obstruction. Obstruction usually occurs after invasion of mesentry and the resulting desmoplastic reaction with scarring. Matting of small bowel loops in turn can produce a mass and intermittently obstruct intestine. Symptoms of partial intestinal obstruction can be the result of an intense desmoplastic reaction characteristic of carcinoid tumor. CASES A 40 year old male reported to our surgical OPD, with one year history of recurrent abdominal pain, vomiting and constipation. Pain was initially colicky in nature which increased in intensity and frequency since past one month. He was also having recurrent vomiting for three months which used to occur 3-4 hours after meals. He also complained of constipation off and on. There was no history of passage of blood per rectum (fresh or altered), hematemesis, or anorexia. The patient had not observed any loss of weight. He had received Anti Tubercular Treatment for 3 months in the past; there was no other significant personal history. There was nothing pertinent in the family history either. Abdominal examination revealed a soft, mildly distended abdomen without any tenderness. No lump or organomegaly was detectable; the bowel sounds were exaggerated. On rectal examination no growth was identified. All the hernial orifices were intact. Rest of the examination was normal. The patient was admitted as a case of recurrent intestinal obstruction most probably due to intestinal tuberculosis. Another possibility of band obstruction was kept in mind. Patient was thoroughly investigated to search for the cause of recurrent obstruction. His blood