Carcinoid Crisis: An Unusual Postoperative Complication of Non-functional Neuroendocrine Tumor of the Pancreas

Abstract

Carcinoid crisis is an uncommon perioperative event in patients with neuroendocrine tumours and is rarely described after surgery for a clinically non-functional pancreatic neuroendocrine tumour. This case describes a 55-year-old man in whom a retro-duodenal mass was incidentally identified during laparoscopic cholecystectomy performed elsewhere for symptomatic gallstone disease. Contrast-enhanced computed tomography demonstrated a heterogeneously enhancing paraduodenal mass measuring 48 × 63 × 64 mm, abutting D1 and D2 and infiltrating the uncinate process, with preserved fat planes around the superior mesenteric vessels. Serum chromogranin was normal, and pancreaticoduodenectomy was performed following a provisional diagnosis of a non-functional pancreatic neuroendocrine tumour. Intraoperatively, the patient developed tachycardia and hypotension that persisted postoperatively despite fluid resuscitation, vasopressor support, and antiarrhythmic management for supraventricular tachycardia. Bleeding and major immediate surgical complications were considered unlikely based on drain output, haemoglobin values, and the clinical course. A clinical diagnosis of carcinoid crisis was considered, and octreotide and hydrocortisone were initiated in addition to ongoing supportive care. Haemodynamic parameters improved over the next 24 hours, allowing withdrawal of inotropic and ventilatory support. The patient recovered without further events and was discharged on postoperative day 10. Histopathology confirmed a well-differentiated G2 pancreatic neuroendocrine tumour, pT3N0Mx, with synaptophysin and chromogranin positivity. This case highlights the need to consider carcinoid crisis in persistent perioperative haemodynamic instability following resection of pancreatic neuroendocrine tumours. Key words: Neuroendocrine tumour, carcinoid crisis, pancreaticoduodenectomy.