Victor Turrado (Gastrointestinal Surgery Specialist)
Gabriel Diaz (Gastrointestinal Surgery Specialist)
Ricard Corcelles (Gastrointestinal Surgery Senior Specialist)
Hospital Clínic, Barcelona – Spain
A 57-year-old male with a previous history of protein C deficiency and a previous midline laparotomy for a non-confirmed mesenteric thrombosis came to the emergency room due to 3 days of epigastric pain. During the examination his vital signs were stable, the abdomen was not distended and presented with mild pain. No clear peritonism was found.
Blood tests were also normal. An abdominal X-Ray was performed, revealing signs of intestinal occlusion.
A Computed Tomography was performed, showing an intestinal occlusion due to a mesenteric lesion suggestive of metastasis of a neuroendocrine tumour (FIG1, red arrow) and an intraluminal lesion in the ileum suggestive of the primary tumor (FIG1, yellow arrow).
An octreo-scan was performed, showing no signs of distant metastasis. There were no alterations in the tumor markers, in the serum, or in the urine hormones.
An exploratory laparoscopy was performed, which showed an important adherence syndrome. A laparotomy was decided and the lesion in the small bowel meso was resected. The lesion in the small bowel and a lesion in the tip of the appendix were identified and resected.
The surgery was uneventful. The patient presented with a mild ileus that was resolved with medical therapy and he was discharged on the 6th postoperative day.