Is a colonoscopy to rule out GI lesions or an OctreoScan required after removal of an appendix with a small carcinoid?

If the carcinoid was greater than 1.5 cm diameter, or if it extended through the appendiceal wall to the serosa or the fat regardless of size, or if mesoappendix or nodes involvement were present – a right hemicolectomy should be done preceded by an OctreoScan.  If it was small and did not meet the above criteria, no colonoscopy or further workup is needed.  Carcinoid syndrome almost always requires a fairly large bulk of metastatic carcinoid and even then almost never results from appendiceal carcinoid.  There are only 2 such cases in the world literature.

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