A 64-year-old woman reported intermittent increasingly severe midabdominal crampy pain for two months. Gastrointestinal inquiry otherwise was unrevealing. The patient had been treated for pulmonary tuberculosis 35 years earlier.A firm mass was palpated to the right of the umbilicus. Several stool specimens were positive for occult blood. The hematocrit reading was normal. The roentgenogram in Fig 1 was obtained toward the conclusion of an antegrade small-bowel examination. Figure 2 shows a fluoroscopic spot film thereupon made of the ileocecal region.
Carcinoid of the terminal ileum plus carcinoma of the cecum.
The small-bowel films (Fig 1 and 2) suggest, and a barium enema examination (Fig 3) subsequently verified, an abrupt irregular annular constriction of the cecum. In addition, as best observed on the ileocecal spot roentgenogram (Fig 2 and 4), the terminal ileum exhibits rigidity and narrowing, with medial angulation. Immediately proximal to this, the lumen, adjacent