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Session: ePoster: Other Neoplasia and Endoscopy 2 (Sun1230)

EP452 - Mesenteric Neuroendocrine Tumor Causing Small Bowel Obstruction

Sunday, May 11, 2025
12:57 PM – 1:02 PM PT
Location: Monitor 7, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • MG

    Maria Guevara-Kissel, MD

    Resident
    Harlem Hospital Center
    New York, New York, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • Shamon Gumbs, MD (he/him/his)

    Resident Physician
    Harlem Hospital
    New York, New York, United States

    Disclosure information not submitted.

  • NI

    Noor Issa, n/a

    Medical Student
    Woodhull Hospital
    New York, New York, United States

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
Maria Guevara-Kissel, MD: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Metastatic mesenteric neuroendocrine tumors (NETs) represent a rare but significant cause of small bowel obstruction (SBO), contributing to considerable morbidity. Neuroendocrine tumors arise from the neuroendocrine cells of the gastrointestinal tract and can metastasize to the mesentery, where they cause fibrosis and mass effects. These mesenteric metastases often lead to structural distortion, compression of bowel loops, and subsequent SBO. Clinical manifestations of SBO include abdominal pain, nausea, vomiting, and distention, requiring prompt intervention.
Diagnosis is typically established through imaging modalities such as computed tomography (CT) or magnetic resonance imaging (MRI), which demonstrate mesenteric masses and bowel obstruction. Functional imaging using somatostatin receptor scintigraphy further aids in detecting primary and metastatic NETs. Management of SBO secondary to metastatic mesenteric NETs often involves surgical intervention to relieve obstruction, debulk the tumor, and address mesenteric fibrosis. In addition to surgical management, postoperative care involving close monitoring for complications, infections or further bowel obstruction along with nutritional support is also indicated. As for medical management, somatostatin analogs, such as octreotide, are the current first line therapy for managing symptoms related to tumor proliferation and hormonal secretion from NETs. However, newer, targeted agents such as peptide receptor radionuclide therapy (PRRT) are being studied as options for patients with advanced disease, potentially offering improved outcomes and survival rates.

Methods/Interventions: We present the case of a 75 y.o male who presented with a high-grade partial small bowel obstruction with an apparent mass encasing the terminal ileum. He was found to have a locally aggressive, well-differentiated (G11, Ki-67 < 1%) neuroendocrine tumor in the mesentery. The patient then underwent an exploratory laparotomy and right hemicolectomy with primary ileocolic anastomosis. Intra-op findings included RLQ retroperitoneal tumor w/ desmoplastic reaction. Tumor encasing/invading the Terminal ileum (proximally dilated loops). Calcified, hard, approximately 3 cm mass at the base of the small bowel mesentery. No peritoneal, liver gross lesions were noted.

Results/Outcomes: Post-op course was unremarkable, and was eventually discharged home. PET-dotatate scan showed only extra-intestinal disease (left supra-clavicular node) and octreotide treatment was initiated.

Conclusion/Discussion: Prognosis depends on tumor burden, response to therapy, and the extent of mesenteric involvement. Early detection and multidisciplinary management are essential to optimize outcomes in patients with this complex condition and reduce the risk of severe complications. Moreover, identifying these tumors in their early stages allows for timely surgical intervention and initiation of tailored treatment leading to a significant improvement in the patient’s quality of life.