Paraneoplastic chronic intestinal pseudoobstruction as a rare complication of bronchial carcinoid.
This report describes paraneoplastic visceral neuropathy including achalasia, gastroparesis, subileus and constipation in a 59 year old patient with metastasising atypical bronchial carcinoid. Achalasia was successfully treated by cardiomyotomy and fundoplication; additionally, extramucosal pylorectomy was undertaken to improve gastric emptying. Endoscopic papillotomy was necessary because of a functional stenosis of the sphincter of Oddi with development of obstructive jaundice. Symptoms of intestinal pseudoobstruction did not improve with cisapride or corticosteroid treatment. Histological examination of gastrointestinal specimens revealed a lymphocytic infiltration of the myenteric plexus associated with loss of neurones. The rheumatoid factor was positive, there was evidence of circulating immune complexes and antibodies to Sm-antigen were present, suggesting a possible autoimmune pathogenesis.
Gerl
A
A
Department of Medicine III, LM University Munich, West Germany.
Storck
M
M
Schalhorn
A
A
Müller-Höcker
J
J
Jauch
K W
KW
Schildberg
F W
FW
Wilmanns
W
W
D001984:Bronchial Neoplasms / Q000150:complications* / Q000473:pathology; D002276:Carcinoid Tumor / Q000150:complications* / Q000473:pathology; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007418:Intestinal Pseudo-Obstruction / Q000209:etiology* / Q000473:pathology; D008875:Middle Aged