Paraneoplastic chronic intestinal pseudoobstruction as a rare complication of bronchial carcinoid

Abstract

This report describes paraneoplastic visceral neuropathy including achalasia, gastroparesis, subileus and constipation in ? 59 year old patient with metastasising atypical bronchial carcinoid. Achalasia was successfuliy treated by cardiomyotomy and fundoplication; additionaily, extramucosal pylorectomy was undertaken to improve gastric emptying. Endoscopic papiliotomy 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 Smantigen were present, suggesting a possible autoimmune pathogenesis.