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The issue is tissue
  1. K Subramaniam1,2,
  2. H C Ee2,
  3. S Fermoyle3,
  4. C W Siah1
  1. 1Department of Gastroenterology, Royal Perth Hospital, Perth, Western Australia
  2. 2Department of Gastroenterology, Sir Charles Gairdner Hospital, Perth, Western Australia
  3. 3Pathwest Laboratory Medicine, Royal Perth Hospital, Perth, Western Australia
  1. Correspondence to Dr Kavitha Subramaniam, Department of Gastroenterology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands 6009, Western Australia; kaviths{at}

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A 69-year-old man, otherwise well, except for ischaemic heart disease and asthma, presented with a 2 year history of crampy abdominal pain relieved with vomiting, intermittent diarrhoea up to 15 times per day and associated 20 kg weight loss. Physical examination revealed a soft abdomen with mild distension. Initial laboratory data were normal. Multiple stool cultures were negative. Plain abdominal radiography and CT revealed dilatation of multiple loops of small and large bowel.

Metabolic, autoimmune, infectious including HIV and tuberculosis), as well as a carcinoid screen including an octreotide scan …

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  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.