Tears of colonoscopy

Clinical presentation

A 72-year-old woman was referred to the gastroenterology outpatient clinic reporting an 18-month history of loose and watery stools up to 10 times per day with nocturnal episodes. She also presented with urgency, occasional faecal incontinence, excessive bloating and flatulence. She had lost 14 kg in weight over the same period. There was no blood or mucus in her stools.

Her symptoms began after she underwent an emergency appendicectomy for suspected appendicitis. The histology revealed a carcinoid tumour, but with clear resection margins and a subsequent CT scan showed no distal spread.

She smoked 10 cigarettes per day and consumed 20 units of alcohol per week. There was no significant family history or history of foreign travel.

On examination her abdomen was soft and non-tender and there were no palpable masses or organomegaly, rectal examination was unremarkable. Laboratory investigations including full blood count, renal and liver function...

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