Female patient, 63 years old, living in Santiago.
She had a history of resection of a tumor of the right peroneal malleolus in childhood, cholecystectomy, and classic cystectomy.
The patient was admitted on 10/day to the Hospital Clínico de la Universidad Católica for a clinical picture of 2 days of evolution, characterized by diffuse colic abdominal pain, abdominal distension, nausea and vomiting, and diarrheal stools.
During the initial evaluation, the patient was irritated with perishate, pulse 62 x', blood pressure signs 120 mmHg and temperature 36.2°C. The abdomen was distended, diffusely sensitive, with no bulging,
increased in quantity and tone.
Blood count: hematocrit 47.1%, leukocytes 9,500 x mm3, without left shift and erythrocyte sedimentation rate 21 mm/hr; C-reactive protein 0.7 mg/dl and normal biochemical profile.
In addition, a computed tomography of the abdomen and pelvis showed loop dilatation at the level of the small intestine, with a zone in the ileum where there was a moderate intestinal nodule 2.6 cm associated with a nonspecific mass segment VI 1.3 cm.
It was evaluated by the digestive surgery team and it was decided to treat the clinical picture medically and complete the laboratory study and images.
The patient recovered satisfactorily, with elimination of gases and stools from the second day onwards.
A CT enterography of the abdomen and pelvis showed multiple nodular and hypervascular lesions in the intestinal wall of the intestinal wall. The intestinal valve was approximately 35 cm distal. These lesions were located in the intestinal wall.
In addition, multiple lymph nodes with a staring appearance were visualized in the mesentery.
We determined the levels of 5-hydroxyindoleacetic acid in the urine of 24 h, which was 47.9 μmol/24 h (VN up to 34).
The patient underwent surgery on 17/6/2005. During surgery, multiple tumoral lesions were found, some with serous involvement, in a segment of 1 meter of the valve and the ileocecalon 40 cm.
In addition, he had multiple lymph nodes in the mesentery, greater than 4 cm and signs of necrosis.
There were no liver or peritoneal metastases.
Intestinal resection of the compromised segment and laterolateral anastomosis were performed.
The patient had a satisfactory postoperative evolution and was discharged on the seventh day of surgery, without seizures.
Biopsy of the surgical specimen confirmed the presence of multiple well differentiated cysts (between 0.3 and 1.8 cm).
In three of them, serosa was compromised.
The margins were negative.
A lymph node of three resected was compromised by the tumor.
In addition, three nodular metastases were found in the mesentery of 4; 1.2 and 0.2 cm. The patient was asymptomatic fifteen months after surgery.
