A 55 year old man presents with acute abdominal pain and diarrhoea of 10 months duration. He has associated weight loss and occasional flushing episodes. Physical examination revealed facial flush and spider like veins. Routine blood counts were normal. Platelet function tests and coagulation tests were normal. Serum bilirubin was normal. AST -120U/L, ALT 113 U/L. Total serum proteins were low. 24 hour urine 5-HIAA is 320 mg/l (Normal value <10).
Barium enema showed a filling defect in the illeoceacal valve. Imaging studies reveal 1.6 cm illeal tumor without metastasis. Somatostatin receptor scintigraphy was positive. A right hemicolectomy with regional lymphadenectomy was performed. During the operative period, the patient develops severe hypotension, tachycardia and generalised flushing of the skin. What has happened to the patient? Source: Silva J et al. Journal of Anaesthesia and…
