Small intestinal carcinoids may present in a multitude of fashions. Which of the following may be seen as a presentation of carcinoid tumors of the small intestine?

a. Intestinal obstruction

b. Gastrointestinal bleeding

d. Asymptomatic 

Many small intestinal carcinoids are small and asymptomatic and are found only incidentally or at autopsy. Clinical symptoms can arise either from the primary tumor, from sequelae of metastatic disease, or from the Carcinoid Syndrome. Obstructive symptoms can occur either from intussusception or more commonly as a submucosal tumor infiltrates the bowel wall and beyond, the bowel mesentery may become shortened, thickened and fixed by an intense desmoplastic reaction characteristic of carcinoid tumors. This leads to kinking and angulation of intestinal loops and may eventually result in mechanical obstruction. Intestinal ischemia or even infarction can occur secondary to an unusual type of mesenteric angiopathy characterized by vascular thickening and sclerosis that accompanies the desmoplastic mesenteric reaction. Although mucosal ulceration and bleeding can occur, such symptoms are unusual.