title: Massive melena caused by a carcinoid of the small intestine: report of a case.
abstract: We report a case of massive melena caused by a carcinoid of the small intestine. A 28-year-old woman was admitted to our department after presenting with massive melena. The source of the bleeding could not be localized by upper or lower gastrointestinal endoscopy, computed tomography (CT), or labeled red blood cell scintigraphy. Enteroscopy allowed visualization only up to the jejunum, and we could not localize the lesion. The melena subsided with conservative treatment, but the patient was readmitted 4 months later when she suffered another episode of massive melena. A contrast CT scan performed immediately showed extravascular leakage and the retention of contrast medium in the ileum. Thus, she underwent an emergency surgery, during which endoscopy confirmed a small ileal tumor accompanied by pulsating bleeding from the exposed blood vessels at its center. The small intestine was partially resected, including the swollen lymph nodes, the size of small beans. Pathological examination confirmed a carcinoid tumor 1 cm in diameter, with an arterial rupture at its center and lymph node metastasis.
authors.affiliation: Department of General Surgery, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo 177-8521, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Fujisawa
authors.forename: Seigo
authors.initials: S
authors.lastname: Ono
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Nakayama
authors.forename: Shingo
authors.initials: S
authors.lastname: Nitta
authors.forename: Shun
authors.initials: S
authors.lastname: Ishiyama
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Shinjoh
authors.forename: Masao
authors.initials: M
authors.lastname: Machida
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Kitabatake
authors.forename: Yoshirou
authors.initials: Y
authors.lastname: Ishibiki
authors.forename: Masahiko
authors.initials: M
authors.lastname: Urao
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Kojima
mesh_terms: D000328:Adult; D002276:Carcinoid Tumor / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D003937:Diagnosis, Differential; D013505:Digestive System Surgical Procedures / Q000379:methods; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007078:Ileal Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D008551:Melena / Q000175:diagnosis / Q000209:etiology*; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed