Akademik Veri Yönetim Sistemi
20.Ulusal ve 3.Uluslararası Türk Kolon ve Rektum Cerrahisi Kongresi, Antalya, Türkiye, 16 - 20 Mayıs 2025, ss.259-260, (Tam Metin Bildiri)
Objective: Neuroendocrine tumors (NETs) are heterogeneous malignancies originating from neural crest-derived cells. In the United States, the small intestine (SI) is the second most common site for NETs after the lungs, with an incidence of 1.3 per 100,000 individuals. Small intestinal NETs are slow growing, prone to metastasis, and typically located within 100 cm of the ileocecal valve. They commonly present with abdominal pain and obstruction. At diagnosis, nearly half of the patients have regional lymph nodes or distant metastases. This report presents a NET case causing small bowel obstruction. Case: A 59-year-old female was admitted to the emergency department with sudden-onset abdominal pain, distension, nausea, and vomiting. Her history included hypertension and asthma. Physical examination revealed periumbilical defense and tenderness. Laboratory tests showed leukocytosis (13,080/ µL) and elevated C-reactive protein (14.2 mg/L). Abdominal X-rays indicated air-fluid levels, while contrast-enhanced computer tomography revealed a jejunal segment stricture due to an intraluminal mass, proximal dilation, and free pelvic fluid (Figure 1a, b). After nasogastric decompression, laparoscopic exploration identified a 5 cm intraluminal mass with desmoplastic reaction, 95 cm proximal to the ileocecal valve (Figure 1c, d). The proximal small intestine was dilated, while the distal segments were collapsed. The affected segment was resected, and a side-to-side jejunojejunostomy was performed. Pathology confirmed a well-differentiated NET (Grade 2, pT3). Gallium-68 DOTA-TATE Positron Emission Tomography (Ga-68 DOTA-TATE PET) detected a metastatic ileal mesenteric lymph node (SUVmax: 18.25) (Figure 1e, f). A second laparoscopic surgery for lymph node dissection confirmed metastasis, staging the patient as pT3N1 (Stage 3). Conclusion: Neuroendocrine tumors (NETs) are rare causes of intestinal obstruction. Additionally, in the presented case, the presence of lymph node metastasis despite the well-differentiated nature of the neuroendocrine tumor is noteworthy. Laparoscopy can be safely utilized in suitable cases for the surgical exploration and treatment of intestinal obstructions. Anahtar Kelimeler: Neuroendocrine Tumor (NET), Small Bowel Obstruction