Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2017; 23(45): 8090-8096
Published online Dec 7, 2017. doi: 10.3748/wjg.v23.i45.8090
Midgut neuroendocrine tumor presenting with acute intestinal ischemia
Ioannis Mantzoros, Natalia Antigoni Savvala, Orestis Ioannidis, Styliani Parpoudi, Lydia Loutzidou, Despoina Kyriakidou, Angeliki Cheva, Vasileios Intzos, Konstantinos Tsalis
Ioannis Mantzoros, Natalia Antigoni Savvala, Orestis Ioannidis, Styliani Parpoudi, Lydia Loutzidou, Despoina Kyriakidou, Konstantinos Tsalis, Fourth Surgical Department, Faculty of Health Science, School of Medicine, Aristotle University of Thessaloniki, “G. Papanikolaou” General Hospital, Thessaloniki 57010, Greece
Angeliki Cheva, Department of Pathology, General Hospital “G. Papanikolaou”, Thessaloniki 57010, Greece
Vasileios Intzos, Department of Radiology, General Hospital “G. Papanikolaou”, Thessaloniki 57010, Greece
Author contributions: Mantzoros I, Savvala NA, Ioannidis O and Tsalis K designed the report; Mantzoros I, Savvala NA, Ioannidis O, Parpoudi S, Loutzidou L and Tsalis K contributed to the clinical diagnosis, evaluation and management of the patient; Parpoudi S, Loutzidou L and Kyriakidou D collected the patient’s clinical data; Cheva A performed the histopathologic analysis; Intzos V performed the radiological studies; Mantzoros I, Savvala NA, Ioannidis O and Tsalis K analyzed the data and drafted the paper; all authors discussed the results and commented and contributed to this manuscript.
Informed consent statement: The patient provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Dr. Orestis Ioannidis, MD, MSC, PhD, Surgeon, Scientific Fellow, Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Alexandrou Mihailidi 13, Thessaloniki 54640, Greece.
Telephone: +30-231-0814161 Fax: +30-231-0551301
Received: August 31, 2017
Peer-review started: September 3, 2017
First decision: September 21, 2017
Revised: October 5, 2017
Accepted: October 26, 2017
Article in press: October 26, 2017
Published online: December 7, 2017

Neuroendocrine tumors represent a heterogeneous group of neoplasms that arise from neuroendocrine cells and secrete various peptides and bioamines. While gastrointestinal neuroendocrine tumors, commonly called carcinoids, account for about 2/3 of all neuroendocrine tumors, they are relatively rare. Small intestine neuroendocrine tumors originate from intestinal enterochromaffin cells and represent about 1/4 of small intestine neoplasms. They can be asymptomatic or cause nonspecific symptoms, which usually leads to a delayed diagnosis. Imaging modalities can aid diagnosis and surgery remains the mainstay of treatment. We present a case of a jejunal neuroendocrine tumor that caused nonspecific symptoms for about 1 year before manifesting with acute mesenteric ischemia. Abdominal X-rays revealed pneumatosis intestinalis and an abdominal ultrasound and computed tomography confirmed the diagnosis. The patient was submitted to segmental enterectomy. Histopathological study demonstrated a neuroendocrine tumor with perineural and arterial infiltration and lymph node metastasis. The postoperative course was uneventful and the patient denied any adjuvant treatment.

Keywords: Small intestine, Carcinoid, Enterochromaffin cells, Jejunum, Enterectomy, Pneumatosis intestinalis

Core tip: The current case report underlines the indolent clinical course with nonspecific symptoms of a small intestine carcinoid that finally caused acute intestinal ischemia. This case also emphasizes the importance of simple imaging modalities, such as X-rays and the abdominal sonography, in the work-up of a patient with intestinal ischemia.