A case of metastatic neuroendocrine disease and cholecystitis: surgical remedy and management of carcinoid crisis. Issue 12 (11th December 2021)

• Record Type: Journal Article
• Authors: Whiley, Phillip J; Balasooriya, Janaka; Wake, Rudyard J
• Is Part Of: Journal of surgical case reports. Volume 2021:Issue 12(2021)
• Publication Date: 2021-12-11
• Subjects: Surgery -- Periodicals; Surgery -- Case studies -- Periodicals; 617.005
• DOI: 10.1093/jscr/rjab543
• Languages: English
• ISSNs: 2042-8812

Abstract

Abstract: The report presents a case of a 70-year-old male with a known mesenteric neuroendocrine tumour and metastases to the liver diagnosed with acute cholecystitis. During surgery, the patient developed a carcinoid crisis with mixed distributive and cardiogenic shock involving systemic vasodilation and arrhythmia. During surgical procedures, carcinoid crisis can be precipitated by tumours that secrete a pathological shower of vasoactive mediators. Somatostatin analogues are utilized to control carcinoid syndrome and are routinely used peri-operatively. However, no standard infusion regimen exists. The case raises the suggestion that metastatic liver neuroendocrine disease may confound the diagnosis of cholecystitis, complicates the management of acute surgical presentations and highlights the need for agreement on octreotide therapy for surgical patients with carcinoid tumours.