University Journal of Surgery and Surgical Specialities
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Intestinal Neuroendocrine Tumour Presenting as Acute Intestinal Obstruction
Abstract
Background: Gastrointestinal tract is the most common site for NETs. After the appendix, small bowel is the second most common site affected. Intestinal NETs are commonly asymptomatic. 70-80% of intestinal carcinoids are asymptomatic and found incidentally at the time of suregry. In literature very few cases of intestinal NETs present as acute intestinal obstruction. Usually they have an indolent, intermittent, or subacute onset with non specific bowel symptoms. So misdiagnosis is common in view of vague symptoms and most cases are treated as irritable bowel syndrome.
Case Presentation : 42 year old female presented with complaints of diffuse abdominal pain and obstipation for 2 days. She also had history of vomiting 2 episodes. No other significant history. On general examination patient was dehydrated with tachycardia. On abdomen examination, there was guarding in the right iliac fossa, hypogastrium and left iliac fossa. Bowel sounds were sluggish. Per rectal examination was normal. Abdomen x ray erect showed multiple air fluid levels. CECT abdomen showed dilated, fluid filled small bowel of diameter 3.2 cm with multiple air fluid levels suggesting small bowel obstruction. It also showed evidence of fat density lesion of size 3 cm noted arising from small bowel loop. Emergency laparotomy was done. Small bowel was dilated from duodeno-jejunal flexure to ileocaecal junction. Large bowel was found to be collapsed.At terminal ileum, 2 cm. proximal to ileocaecal junction a 3*2 cm irregular mass was palpable. A complex cyst of size 3*3 cm was found in the right ovary. Right hemiclectomy with ileotransverse anastomosis along with right oopherectomy was done. HPE report was well differentiated neuroendocrine tumour grade 1 with mature cystic teratoma of right ovary.
Conclusion : Till now only few cases of NET presenting as acute obstruction have been reported in literature. Carcinoid tumors are rare tumors of the Gastro intestinal tract, however, are the most common primary tumors of the small intestine. Most of these tumors have a very indolent course and may present with non specific symptoms. However in this case intestinal NET presents as acute intestinal obstruction
Keywords: Neuro endocrine tumor, acute intestinal obstruction, Right hemicolectomyFull Text:
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