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Paraneoplastic chronic intestinal pseudoobstruction as a rare complication of bronchial carcinoid.
  1. A Gerl,
  2. M Storck,
  3. A Schalhorn,
  4. J Müller-Höcker,
  5. K W Jauch,
  6. F W Schildberg,
  7. W Wilmanns
  1. Department of Medicine III, LM University Munich, West Germany.

    Abstract

    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.

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