Small intestinal neuroendocrine tumor: a case report and literature review
Ayoub Errabhi, Ahmed Vadel Jidou, Ayoub Ben Chaayab, Abdelali Guellil, Rachid Jabi, Mohammed BouzianeIntroduction and importance:
Small intestinal neuroendocrine tumors (NETs) are rare neuroendocrine neoplasms, often asymptomatic or associated with functional carcinoid syndrome. Diagnosis is based on biochemical markers (urinary 5-HIAA, chromogranin A) and imaging studies. Management includes surgical resection and, in metastatic cases, somatostatin analogues and targeted therapies.
Case presentation:
A 52-year-old male with a history of appendectomy for acute simple appendicitis presented with sub-occlusive symptoms, including intermittent vomiting and diffuse abdominal pain without signs of peritonitis. Laboratory findings revealed elevated chromogranin A levels (140 ng/mL). Abdominopelvic CT identified an early ileal obstruction with an associated mesenteric mass and retractile mesenteritis, suggestive of an NET. The patient underwent ileocecal resection with mesenteric mass excision. Postoperative recovery was uneventful. Histopathological analysis confirmed the diagnosis of a NET.
Clinical discussion:
NETs, most commonly found in the small intestine, are often asymptomatic or present with complications such as obstruction. Diagnosis relies on chromogranin A and 5-HIAA tests, with imaging showing retractile mesenteritis. Treatment involves surgical resection for localized tumors and somatostatin analogs or radiotherapy for metastatic cases.
Conclusion:
This case underscores the diagnostic challenges posed by small bowel NETs due to their nonspecific clinical presentation. It highlights the value of integrating biochemical markers and imaging in diagnosis and confirms that timely surgical management can lead to favorable outcomes.